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SMITHSONIAN INSTITUTION 

BUREAU OF AMERICAN ETHNOLOGY 

BULLETIN 42 



TUBERCULOSIS AMONG CERTAIN 
INDIAN TRIBES OF THE 
UNITED STATES 



BY 

ALES HRDLICKA 




WASHINGTON 

GOVERNMENT PRINTING OFFICE 

1909 



PREFATORY NOTE 



The accompanying paper by Dr. Ales Hrdlicka presents a detailed 
account of the investigations made by him under the j oint auspices of 
the Office of Indian Affairs and the Smithsonian Institution, into the 
condition with regard to tuberculosis of five selected Indian tribes of 
the United States. An exhibit and a preliminary account of this 
work were submitted by Doctor Hrdlicka to the Sixth International 
Congress on Tuberculosis at its session held at Washington in Sep- 
tember and October, 1908. In the investigation above referred to, 
which took place in the summer of 1908, Doctor Hrdlicka was 
assisted by Dr. P. B. Johnson, bacteriologist. 

While the gravity of the conditions dealt with in this paper, from 
the standpoint of the physical well-being of both the Indians and the 
whites, is generally understood and appreciated by intelligent stu- 
dents of the subject, the serious and often insurmountable difficulties 
encountered by the Office of Indian Affairs in its task of devising and 
applying corrective measures are not always so readily recognized. 
In some cases the difficulty is the lack of necessary legislation; in 
some, the impracticability of exercising sufficiently close supervision 
over even those Indians disposed to accept the white man's counsel; 
in still other cases the compulsory measures which would be neces- 
sary to bring about the desired result do not have the sanction of 
Congress or of public opinion. 

These are, briefly, a few of the obstacles which stand in the way of 
those who are seeking to lead the Indians in the paths of civilization 
and to promote their sanitary condition. Under these circumstances, 
it is gratifying to know that, at no previous time in its history, has 
the Office of Indian Affairs been more awake to the true state of 
affairs, and that, through its agency, as stated by Doctor Hrdlicka, 
" improvement of existing conditions is being brought about as 
speedily as is practicable." Indeed, since the accompanying paper 
was written, changes in the service looking to the betterment of the 
Indian have been made, and there is every reason to expect a con- 
tinuation of progress toward more sanitary living among the Indians 
with a consequent diminution of the ravages of tuberculosis and 
other diseases. 

W. H. Holmes, 

Chief. 

in 



CONTENTS 

Page 



I. Introduction 1 

II. Morbidity and mortality 3 

Table 1. Morbidity from tuberculosis among United States Indians 

during 1904 4 

Table 2. Mortality from tuberculosis among United States Indians, 

during fiscal year 1907-8 5 

III. Scope of investigations 7 

IV. Results of investigations, by tribes 8 

Menominee 8 

Oglala Sioux 11 

Quinaielt 14 

Hupa 16 

Mohave 17 

Table 3. General data for tribes visited 20 

Statistical data for tribes visited 24 

Table 4. Results of examination (1908) of family groups 24 

V. Symptomatology 28 

VI. Etiology..... 29 

VII. Therapeutics 32 

Bibliography 37 

Index 45 



v 



ILLUSTRATIONS 



Plate 1. Menominee village and isolated house. 

2. Menominee houses. 

3. Menominee houses and farm. 

4. Menominee frame house. 

5. Oglala dwellings. 

6. Oglala tent dwellings. 

7. Oglala log houses. 

8. Oglala dwellings. 

9. Oglala dwellings. 

10. Quaitso (Queets) Indians from the Quinaielt reservation. 

11. Quinaielt village of Taholah. 

12. Quinaielt children; specimens of basketry. 

13. Hupa dwellings. 

14. Hupa dwellings. 

15. Hupa frame house. 

16. Hupa large frame house. 

17. Hupa dwellings of the poorer class. 

18. Mohave shelters. 

19. Mohave dwellings. 

20. Mohave dwellings. 

21. Mohave dwellings and sweat house. 

22. Mohave dwellings. 



TUBERCULOSIS AMONG CERTAIN INDIAN TRIBES 
OF THE UNITED STATES 



By Ales Hrdlicka 

I. INTRODUCTION 

The increasing prevalence of tuberculosis in all its forms among 
the Indians in many parts of this country demands the special atten- 
tion of the student of the subject and calls for vigorous attempts to 
limit the spread of the infection. 

It is not positively known whether or not tuberculosis existed 
among the natives of this continent before the advent of the whites. 
That it was rare, if it did exist, may be judged from the following 
indications: (1) No reference to the prevalence of tins disease among 
the Indians is made by the writers who reported on the period of 
the earliest contact of the whites with the various tribes. (2) There 
are to this day among the Indians a scarcity of remedies and a lack of 
specialized forms of treatment for this disease. (3) In many tribes 
the testimony of the old Indians is to the effect that diseases of the 
kind were unknown or but seldom seen among tlHtfn in their early 
days, or in the still earlier times of which information had come 
down to them. (4) The old men and women in many of the tribes 
are remarkably free from signs of tuberculosis of the lymph nodes 
and bones. (5) The whites who have been long in contact with 
the Indians, particularly in the Southwest, all speak of the spread 
of the disease within their memory, while the observations of ex- 
plorers and men of science indicate a progressive decrease in most 
localities as we recede into the past. (6) As yet no bones of un- 
doubtedly pre-Columbian origin have been found that show tuber- 
culous lesions, and such lesions are very rare in Indian bones 
dating from the period of the earliest contact with the whites. 
(7) The Indian presents everywhere a greater susceptibility to the 
disease than the white man; this means a lesser immunization of 
his system, indicating the more recent introduction of the infection 
into his race. (8) It is to be assumed on purely logical grounds that 
the disease must have been much less frequent among the Indians 
in former times when they lived a more natural and active life, were 
better inured to hardships, and, with exception of particular localities 
and periods, were better provided with suitable food. 

1 



2 



BUEEAU OF AMERICAN ETHNOLOGY 



[bull. 42 



It is difficult to trace the early spread of tuberculosis among the 
Indian tribes, because of the meagerness of the information at our 
disposal. As early as 1615 a there occur references to diseases of 
the ' ' chest " — some of which may have been of a tuberculous nature — 
among the Tarasco of Michoacan. In the seventeenth and eight- 
eenth centuries, especially the latter, both scrofula and consumption 
were, according to the Jesuit fathers/ already common among the 
Montaignes and other tribes in New France. 

Of the spread of the disease through the remaining tribes but little 
is known until we come down into the nineteenth century. As late 
as 1794 such an authority as Dr. Benjamin Rush, whose knowledge 
was probably limited to the eastern Indians south of Canada and 
New England, states that tuberculosis "is unknown among the 
Indians in North America." Similar reports will be found in the 
Bibliography. By the end of the first quarter of the nineteenth 
century, however, the disease was certainly widely disseminated, 
though still rare, according to Long, Hunter, Morton, and others, 
among the Indians of the Central states and the Missouri valley. 
Before the century closed it existed in all parts of the country, and 
at the present time no tribe in the whole of North America is exempt. 

The special study of tuberculosis among the Indians in the United 
States is. a matter of recent years only, dating, in fact, from the 
establishment, about twenty -five years ago, of the regular Indian 
medical service. Unfortunately, there are as yet in existence no 
exact and comprehensive data on the subject. The physicians in 
the Indian Service report regularly on all the diseases treated, but 
the reports have not always been complete or accurate. The first 
extensive, published statistics relating to tuberculosis in Indians are 
found in the United States Census reports, particularly those for 
1890 and 1900, but these also can not be regarded as entirely satis- 
factory for the purpose in view. Original research in this subject 
may be said to have been begun in the " eighties" by Dr. Washington 
Matthews. 0 Subsequent to this, in 1894, Dr. H. R. Bull published obser- 
vations on the disease among the pupils of the large nonreservation 
Indian school at Grand Junction, Colo. A series of valuable notes and 
data on pulmonary tuberculosis among the Pine Ridge Sioux, collected 
during the last fifteen years,, was reported by Dr. J. R. Walker in 
1906, before the National Association for the Study and Prevention 
of Tuberculosis. In the same year an account of the disease in 
Arizona and New Mexico, based on special reports of the agency and 
school physicians, was published by Dr. I. W. Brewer, and one year 
later an interesting paper in this line by Dr. Woods Hutchinson 0 ap- 

a Hernandez, F., and F. Ximenez, Plantas, Animales e Minerales de Nueva Espafia, usados en la 
Medicina. .Mexico, 1G15; Leon ed., Morelia, 1888. 
b Jesuit Relations, Thwaites edition; see Bibliography, 
c See Bibliography. 



hrdlicka] TUBERCULOSIS AMONG CERTAIN INDIAN TRIBES 



3 



peafed. Since 1900 inquiries as to the disease have also been made 
among the various tribes of the Southwestern states and northern 
Mexico by the writer. In 1904, under the auspices of the Indian 
Office, he collected from its physicians information as to the mor- 
bidity due to tuberculosis among all the Indians of the United 
States. The results of these studies have recently appeared as 
Bulletin 34 of the Bureau of American Ethnology. At the beginning 
of last summer a further step was taken by the Indian Office in call- 
ing on its physicians for statistics as to the morbidity and mortality 
due to tuberculosis among the Indians during the fiscal year 1907-8. 
Finally, in preparation for the Sixth International Congress on 
Tuberculosis, the Indian Office and the Smithsonian Institution 
united in asking the writer to formulate a plan for a brief, direct 
research into the subject in a number of selected tribes, and detailed 
him, with Dr. P. B. Johnson, bacteriologist, to carry out the inves- 
tigation. The results of this were presented to the congress in the 
form of an exhibit and a preliminary communication, and are detailed 
more fully in this paper. 

II. MORBIDITY AND MORTALITY 

The most extensive data concerning the prevalence of tuberculosis 
among the Indians are (1) the census reports, (2) the above-men- 
tioned statistics on the morbidity due to tuberculosis, collected by 
the writer from physicians in the Indian Service in 1904, and (3) the 
statistics on mortality from the -disease gathered by the Indian Office 
during the present year (1908). No one of these series of data is 
perfectly accurate, particularly with regard to the larger reserva- 
tions, where it is impossible for the physician to know of all the cases. 
Still, they are sufficiently valuable to deserve publication in this con- 
nection. 

The data on the morbidity due to tubercular conditions included 
91 acceptable reports, dealing with an Indian population of 107,000 
individuals. These reports recorded 2,836 cases of the disease, 
divided as follows: pulmonary tuberculosis, 1,038; tuberculosis of 
bones and joints, 208; glandular tuberculosis, 1,590; or to every 100 
cases of pulmonary tuberculosis there were 20 cases of tuberculosis 
of bones and joints and 153 of the glandular variety. 

The proportion of the several forms of the disease to the popula- 
tion was as follows: 

Cases per 
1,000. 

Pulmonary tuberculosis. 9. 7 

Tuberculosis of bones and joints 1. 95 

Glandular tuberculosis 15. 0 

The detailed data are subjoined. Following these are the 1908 
statistics on the mortality from tuberculosis, which are doubtless of 
greater accuracy than the previous ones. The two series, however, 
show a fair general agreement. 



BUEEAU OF AMERICAN ETHNOLOGY 



[bull. 42 



Table 1. — Morbidity from tuberculosis among United States Indians during 1904 



Designation. 



Agency or school, with location. 



Cases of tuberculosis per 
1,000 population. 



Pul- 
mo- 
nary. 



Bones 
and 
joints. 



Hupa 

Menominee 

Quinaielt 

Sioux (Oglala) 

Sioux 

Sioux (mixed) 

Mohave 

Sioux (Lower Yanktonai).. . 

Ute 

Assiniboin and Sioux 

Oto 

Sioux (Yankton) 

Cheyenne 

Cheyenne 

Paiute 

Apache 

Iroquois (Oneida) 

Crows 

Potawatomi 

Hopi 

Indians 

Walapai 

Sauk and Foxes 

Arapaho 

Pawnee 

Sioux 

Shoshoni 

Indians 

Shoshoni and Bannock 

Quileute 

Pima 

Indians 

Winnebago 

Kickapoo 

Indians 

Piegan 

Sioux 

Shoshoni 

Indians 

Cheyenne and Arapaho 

Coeur d'Alenes 

Apache 

Shawnee 

Yuma 

Chippewa 

Indians 

Assiniboin and Grosventres. 

Omaha 

Mohave 

Iroquois (Oneida) 

Apache 

Shoshoni and Arapaho 

Navaho 

Navaho 



Hupa Valley Agency, Cal 

Green Bay Agency, Wis 

Puyallup Agency, Wash 

Pine Ridge Agency, S. Dak 

Lower Brule Agency, S. Dak 

Rosebud Agency, S. Dak 

Colorado River Agency, Ariz 

Crow Creek Agency, S. Dak.. _ 

Ute Agency, Utah 

Fort Peck Agency, Mont 

Oto Agency, Okla 

Yankton Agency, S. Dak 

Cantonment, Okla 

Tongue River Agency, Mont 

Nevada Agency, Nev 

Mescalero Agency, N. Mex 

Oneida School, Wis 

Crow Agency, Mont 

Shawnee, Okla 

Hopi Agency, Ariz 

Shawnee Agency, Okla 

Truxton Canyon Agency, Ariz 

Sauk and Fox Agency, Okla 

Cantonment, Okla 

Pawnee Agency, Okla 

Devils Lake Agency, N. Dak 

Western Shoshoni, Nev 

Umatilla Agency, Oreg 

Fort Hall, Idaho 

Neah Bay Agency, Wash 

Pima Agency, Ariz 

Round Valley, Cal 

Winnebago Agency, Nebr 

Kickapoo School, Kans 

Flathead Agency, Mont 

Blackfeet Agency, Mont 

Standing Rock Agency, N. Dak 

Lemhi Agency, Idaho 

Colville Agency, Wash 

Cheyenne and Arapaho Agency, Okla 

Colville Agency, Wash . 

Fort Apache Agency, Ariz 

Shawnee School, Okla. . ; 

Fort Yuma School and Reservation, Ariz. 

Leech Lake Agency, Minn 

Fort Berthold Agency, N. Dak 

Fort Belknap Agency, Mont 

Omaha Agency, Nebr 

Fort Mohave School, Ariz 

Oneida Agency, Wis 

Jicarilla Agency, N. Mex 

Shoshoni Agency, Wyo 

Navaho Agency, N. Mex 

San Juan Agency, N. Mex 



24.2 
1.6 



6.8 
4.2 



.9 
6.3 
4.2 



2.3 
5.4 



3.2 
43 



3.7 



1.1 


12.7 


3.1 


4.6 


1.8 


5.5 


5.0 


10.1 


2.7 


4.9 


2.9 


8.3 


2.0 


22.7 


6.4 




5.9 


32.5 


2.3 


12.3 


1.7 


13.8 


.5 


3.9 


1.7 




1.5 


(?) 
7.4 


.8 


4.1 


3.2 


8.1 


2.3 


16.3 


1.1 


6.7 


.5 


7.3 
1.3 




.6 


.6 


.2 
.1 



hrdliCka] 



TUBERCULOSIS AMONG CERTAIN INDIAN TRIBES 



Table 2. — Mortality from tuberculosis among United States Indians, during fiscal 

year 1907-8 « 



Tribe. 



Agency or school. 



Census 
June 30, 
1907. 



Deaths from pulmonary tuberculosis. 



For 
year 
1907-8. 



Pro- 
por- 
tion 
per 
1,000 
popu- 
lation. 



Males 
over 
16 

years. ?> 



Fe- 
males 
over 
16 
years. 



Chil- 
dren 

under 
16 

years. 



Deaths 
from 
tuber- 
culosis 
other 
than 
pul- 
mo- 
nary. 



Kiowa, Okla 

Red Lake, Minn 

Cheyenne and Arapaho, 
Okla. 

Siletz, Oreg 

Santee.Nebr 



Apache 

Chippewa 

Cheyenne and 
Arapaho. 

Siletz Indians 

San tee Sioux and 
Ponca. 

Gr os ventres 

Tulalip 

Sioux 

Sioux 

Paiute 

Cceur d'Alenes,etc 

Muckleshoot 

Oglala Sioux 

Mohave 

Port Madison 

"Wichita 

Comanche 

Paiute 

Assiniboin 

Arikara 

Oto 

Shoshoni 

Yanktonai Sioux.. 

Hupa 

Southern Ute 

Apache 

Apache 

Menominee 

Bannock and Sho- 
shoni. 

Chippewa 

Yanktonai Sioux.. 

Mandan I Fort Berthold, N. Dak. 



Fort Belknap, Mont 

Tulalip, Wash 

Standing Rock, N. Dak. . . 

Rosebud, S. Dak 

Panguitch, Utah 

Coeur d'Alene, Idaho 

Tulalip, Wash 

Pine Ridge, S. Dak 

Colorado River, Ariz 

Tulalip, Wash 

Kiowa, Okla 

Kiowa, Okla 

Walker River, Nev 

Fort Peck, Mont 

Fort Berthold, N. Dak.. . . 

Oto, Okla 

Western Shoshoni, Nev. . . 

Fort Peok, Mont 

Hupa, Cal 

Fort Lewis, Colo 

Mescalero, N. Mex 

San Carlos, Ariz 

Green Bay, Wis 

Fort Hall, Idaho 



159 
1,324 
1,276 

448 
1,374 

553 
402 

3,393 

5,011 
223 
601 
155 

4,099 
482 
174 
441 

1,440 



La Pointe, Wis . . 
Yankton, S. Dak. 



Hopi, Ariz 

Tulalip, Wash 

Hopi, Ariz 

Uinta and Ouray, Utah. . . 
Crow Creek, S. Dak 



1,145 
424 
453 
466 
2,191 
1,375 
1,782 

5,081 
1,716 
263 
2,000 
273 
2,000 
1,261 
1,028 



1,065 
620 



1,235 
627 



6.5 
6.4 



Navaho 

S winomish 

Hopi 

Ute 

Lower Yanktonai 
Sioux. 

Winnebago ! Winnebago, Nebr. 

Round Valley In- Round Valley, Cal 
dians. 

Kiowa Kiowa, Okla 

Ponca and Ton- ! Ponca, Okla 

kawa. 

a Compiled from special statistics gathered by the Indian Office from agency physicians, 
b Indian Office classification. 

c Of the four districts to which the statistics apply. 



25.1 
23.4 
21.9 

17.9 
17.5 

16.3 
14.9 
14.7 
14.0 
13.5 
13.3 
12.9 
12.4 
12.4 
11.5 
11.3 
11. 1 
10.7 
10.7 
10.3 
10.3 
10.3 
9.6 



8.6 
8.2 
8.0 
7.8 

7.7 
7.6 
7.6 
7.5 
7.3 
7.0 
7. 1 
6.8 



11 I 
26 

1 

1 

1 

18 
4 
2 
3 
4 
4 
3 
1 
3 
2 
4 
1 
2 
3 
4 
6 
5 

14 
4 
1 
6 
1 
3 
4 
2 



6 



BUREAU OF AMERICAN ETHNOLOGY 



[bull. 42 



Table 2. — Mortality from tuberculosis among United States Indians, during fiscal 

year 1907-8 — Continued 



Tribe. 



Agency or school. 



Census 
June 30, 
1907. 



Deaths from pulmonary tuberculosis . 



For 
year 
1907-8. 



Pro- 
por- 
tion 
per 
1,000 
popu- 
lation. 



Males 
over 

16 
years. 



Fe- 
males 
over 

16 
years. 



Chil- 
dren 
under 

16 
years. 



Deaths 
from 
tuber- 
culosis 
other 
than 
pul- 
mo- 
nary. 



Grosventres 

Sioux 

Pima, Papago, and 

Maricopa. 
Sauk and Foxes, 

and Iowa. 

Omaha 

Lummi 

Caddo 

Apache 

Flatheads, etc 

Pueblos 

Eastern Cherokee. . 
Navaho 



Fort Berthold, N. Dak. 
Fort Totten,N. Dak... 
Pima, Ariz 



Sauk and Fox, Okla. 



Omaha, Nebr 

Tulalip, Wash 

Kiowa, Okla 

Fort Apache, Ariz 

Flathead, Mont 

Santa Fe, N. Mex 

Eastern Cherokee, N. C. 
Navaho, Ariz 



468 
986 
6,478 

608 

1,246 
414 
555 
2,083 
2,221 
3, 419 
1,550 
12, 500 



0.4 
6. 1 
5.7 



4.8 
4.8 
3.6 
3.4 
3.1 
2.0 
1.9 
1.7 



18 



Total. 



81, 388 



641 



a 7. 9 



2'22 



235 



184 



M82 



aAinong the whites of the United States the average proportion of deaths from pulmonary tuberculosis 
per 1,000 population is approximately 1.7; among the negroes about 4. 
b 2.2 per 1,000 population. 

The above statistics show: 

(1) That the morbidity and mortality from all forms of tubercu- 
losis among the Indians to-day exceed by far those among the whites 
generally; and that their average exceeds even the very high rate 
among the American negroes. 

(2) That the disease, while most prevalent in northern and north- 
western United States and in certain regions in Oklahoma, presents 
no definite distribution according to territory and climate. Nearly 
all of the tribes that have long been in contact with the whites, and 
that have advanced more or less in civilization, are seriously affected. 
On the other hand, most of the least affected tribes have been less in 
contact with the whites and live not only in a favorable climate, but 
also, to a large degree, in their native manner. Judging from the 
Pueblos, who are among the tribes most free from tuberculosis, the 
contact of the Mexicans was not as detrimental as was that of the 
whites from the east and north of the continent. The natives most 
free from tuberculosis — the Navaho — occupy an extensive and natu- 
rally healthful region, where they live under conditions more nearly 
aboriginal than those found in any other locality north of Mexico. 
The tribe no doubt suffers more from tuberculosis than is indicated 
in the reports of the Indian Office, for the size of the territory and the 



hrdlicka] TUBERCULOSIS AMONG CERTAIN INDIAN TRIBES 



7 



number of its people make it impossible as yet to obtain exact data. 
Still, there are many indications that in this tribe the proportion of 
tuberculous cases is very small where contact with the whites is 
restricted. An exception is found among the Navaho on the Hopi 
reservation, who already show infection to about the same extent 
as the Hopi themselves. 

III. SCOPE OF INVESTIGATIONS 

The investigations on Avhich this report is based were pursued in 
five of the tribes, shown in the above-mentioned data to be most 
afflicted with tuberculosis, and in one of the large nonreservation 
schools. The tribes in question are the Menominee in northeastern 
Wisconsin; the Oglala Sioux in South Dakota; the Quinaielt on 
the seacoast and along the river of the same name in northwestern 
Washington ; the Hupa in northwestern California ; and. the Mohave, 
on the Colorado river between Needles, Cal., and Yuma, Ariz. 
These tribes were selected not only because of the prevalence among 
them of tuberculosis, but also because they live under widely differing 
conditions of climate, environment, civilization, and contact with 
the whites. The school visited is the one at Phoenix, Ariz. The 
investigation was carried on during the two months of midsummer 
when people everywhere are most free from the various bronchial and 
pulmonary affections that might complicate a diagnosis. 

On account of the short time available, and the extensive ground 
to be covered, the study had to be limited to what was most essential 
toward obtaining reliable statistics. In the smaller tribes, as the 
Hupa and the Mohave, nearly all the dwellings were visited, and all 
the members of the tribe who were not far distant were studied. In 
the larger tribes, as the Menominee and the Oglala, the exam- 
inations were limited to one hundred families. Among the Oglala, 
these one hundred families included only full-bloods, who in this 
tribe suffer more from tuberculosis than do the half-breeds. 

The actual work consisted in visiting the dwellings consecutively 
and making a personal examination of each member of every family, 
healthy or not healthy. In many families absent members were 
brought from many miles away by the Indians themselves for exam- 
ination. This examination embraced the lungs, heart, glands of the 
neck, and skeleton, and was supplemented by inquiries. Whenever 
a case was encountered in which the presence of phthisis seemed 
probable, an effort was made to secure a sample of the sputum. 
This was sent back to the bacteriologist, who had meanwhile estab- 
lished himself in a convenient place at the agency. A satisfactory 
sample of sputum was not always obtainable, however, and it was 
seldom possible to secure more than one specimen from the same 
subject. Tuberculin tests and opsonic determinations, though very 



8 



BUREAU OF AMERICAN ETHNOLOGY 



[bull. 42 



desirable, could not be employed on account of the short time avail- 
able. The writer is well aware that in their absence his work is 
incomplete and not fully satisfactory. Nevertheless, the results can 
be safely regarded as more accurate than any secured hitherto by 
general observation. 

The investigation was everywhere promoted by the Indians them- 
selves, who welcomed an inquiry into the disease which is deci- 
mating them, the gravity of which they well appreciate, but against 
which they feel utterly helpless. 

IV. RESULTS OF INVESTIGATIONS, BY TRIBES 

The results will be presented in as brief form as is consistent with 
their importance. They consist of general data regarding the actual 
state of the different tribes, and statistical data based on the exami- 
nations made. a 

Menominee 

The Menominee, according to the latest census, number 1,464 in- 
dividuals, of whom 784 are males and 680 females. The excess in 
number of males over females is not natural, but is mainly due to the 
fact that remnants of related people living in the neighboring tribes 
apply for and receive admission into the tribe and more males than 
females are admitted. Were it not for this accession, the Menominee, 
notwithstanding a high birth rate, would show a gradual decrease in 
numbers as a result of the high mortality largely caused by tubercu- 
losis. 

These Indians occupy parts of an extensive reservation in north- 
eastern Wisconsin, about 50 miles west of Lake Michigan. They have 
lived in the same general region since our first knowledge of them, and 
may be considered, therefore, as well inured to its climatic peculiari- 
ties. The surface of the reservation is partly flat and partly of an 
irregular, rolling character, with many small hills and depressions. 
Much of the land is covered with mixed woods, in which pine pre- 
dominates. The soil is sandy and clayey. Water is very abundant, 
there being more than thirty small lakes and several fair-sized rivers; 
there are no undrained bodies of water or swamps. The water in 
most of the lakes contains traces of iron and lime, but no sulphur. 

The climate is rather moist and cool. There is no dry season; the 
rains are particularly abundant in spring and fall, lasting sometimes 
upwards of a week at a time; snow is also plentiful. The tempera- 
ture rarely rises higher than 85° F. in summer and drops, though not 
frequently, to as low as 30° below zero in winter. Winter begins 
usually late in November and ends during the latter half of March. 
Winds are highest from March to June. They blow mainly from 



a In this connection the writer expresses his indebtedness for valuable assistance, to the agents and 
the agency physicians of the several reservations. 



hrdlicka] TUBERCULOSIS AMONG CERTAIN INDIAN TRIBES 



9 



the west and northwest and are seldom of more than moderate ve- 
locity. There are no sand storms. In general, the climatic condi- 
tions are such as to favor the development of catarrhal affections of 
the respiratory organs in both whites and Indians. 

The Menominee are to-day almost wholly a tribe of mixed-bloods. 
Among more than five hundred members of the tribe with whom the 
writer came in direct contact not more than two aged individuals 
had the appearance of pure-blood Indians. Much of the mixture 
dates from the time of the relations of the people with the French, 
but regular marriages of white men and even of women into the tribe 
have not been rare and occasionally occur at the present day. 

The people are, in general, well advanced in civilization; this is es- 
pecially true of those in the neighborhood of the agency. The ma- 
jority live in fairly good log or frame houses, built according to the 
plans of the whites. (Pis. 1-4.) These dwellings are, as a rule, iso- 
lated, and surrounded by good-sized gardens, or by vacant grounds 
on which grow forest trees. The floors of the houses are, with few 
exceptions, made of boards, lumber being abundant. 

The log dwellings are warmer than the frame houses. In a number 
of instances the latter seemed rather frail in construction, and must 
be cold in winter. All of the dwellings admit of good ventilation and 
there is little fault to find in this respect in summer, in the day time 
especially. At night, however, the windows and doors are habitu- 
ally closed, and in cold weather every crevice is stopped, and then, 
doubtless, the conditions are insanitary. As to cleanliness, a ma- 
jority of the dwellings were found in a fairly good condition. 

The clothing of the people is quite clean, being similar to that of 
the whites. There was observed, however, a tendency to wear too 
much clothing even on the warmest days of the summer. It was not 
uncommon to find a child or a grown person wearing two, or even 
three shirts, one of which was not infrequently of wool. This habit is 
injurious; many of those so thickly clothed were found perspiring, 
and oversensitive to exposure. 

For food, the Menominee prefer meat, especially salt pork, which 
is very extensively eaten. The writer observed their meals on numer- 
ous occasions, and found them to be less regular than among the 
whites and often poor in every respect; only occasionally was a really 
well-provided table seen. Gravies and pastries are much favored; 
coffee and tea are drunk in large quantities, often at the expense 
of more nourishing substances; and everyone seems fond of sweets. 
Beans and other garden products are liked, but the supply is small. 
Some of these Indians catch a fair quantity of fish, while others raise 
a few chickens. Game is scarce. During spring and summer large 
quantities of berries of different kinds are gathered to be eaten fresh 
or dried, or to be made into preserves. 
71530— Bull. 42—09 2 



10 



BUEEAU OF AMERICAN ETHNOLOGY 



[bull. 42 



The chief occupations of the Menominee are logging and lumbering, 
which furnish work to nearly all able-bodied male Indians for seven 
or eight months each year. During this "season/' which lasts 
from the time cold weather sets in until late in the spring, there is 
but little idleness among the men who can work. But this period 
is not without its dangers to their health. Those employed at log- 
ging are frequently wet, while some use intoxicants more freely 
during this time and expose themselves to the weather. As a result, 
attacks of rheumatism often follow, which, in many instances, leave 
those affected, with defective hearts. The proportion of those so 
affected — principally with mitral insufficiency — is almost incredibly 
large in this tribe, amounting to more than 30 per cent of the popu- 
lation. The lesions are found chiefly in men who have been engaged 
in logging, but occasionally in women; they were observed invariably 
in one or more children of a family in which the father or mother 
was affected with heart trouble for a time antedating the birth of 
such children. However, the individuals thus afflicted have not 
shown any greater percentage of tuberculosis than others. 

Farming is neglected on account of the work in the woods and saw 
mills, yet all cultivate a little ground. (PI. 3.) The women occupy 
themselves only with household duties and some gardening. 

In July, 1908, the Menominee owned about 165 cows. The milk is 
used principally fresh, or in bread, or is eaten sour with addition of 
sugar. None of these cows had ever been examined for tuberculosis. 
Some of them, kept by the people who live in Keshena, the settlement 
about the agency (pi. 1), were seen daily on the main street of the 
village, browsing on grass which undoubtedly is often contaminated 
by the expectorations of the healthy as well as of the consumptives. 

In their general habits the Menominee are a mild, tractable, and 
domestic people, who, under more favorable conditions, could soon 
take their place among free citizens. Their main failing is drunken- 
ness which, notwithstanding punishments and precautions, con- 
tinues to prevail. Liquor is obtained surreptitiously from whites; 
this consists of whiskey of inferior grade and occasionally of alcohol, 
the latter more or less diluted. A creek near the reservation, which 
conveniently furnishes water used by the Indians for dilution of alco- 
hol, is already known as " Alcohol creek." The passion for strong 
drink affects both men and women. Its main causes are, in a few 
cases, early dissipation, and in others, a craving for a stimulant of 
some sort, due to lack of sufficient or proper nourishment. The 
results are injurious, particularly as regards tuberculosis. 

The diseases most prevalent on the reservation, besides tuberculosis 
and the above-named heart affections, are various disorders of the 
respiratory apparatus, and rheumatism; malarial affections are com- 
paratively rare. 



hrdlicka] TUBERCULOSIS AMONG CERTAIN INDIAN TRIBES 11 

Oglala Sioux 

This tribe occupies a reservation in South Dakota nearly 5,000 
square miles in extent. It numbers according to the last count 
6 ; 663 individuals, of whom 3,325 are males and 3,328 females. The 
population is suffering a gradual diminution owing to the high death 
rate, due mainly to tuberculosis. 

About three-fifths of the Oglala are still full-bloods, the remainder 
being nearly all half-breeds, the result of clandestine unions of the 
Indian women with white men. This mixture is nearly all of quite 
recent date. The writer examined in this tribe 100 pure-blooded 
families. 

The region in which the Oglala live, while not identical with the 
one over which they roamed when free, is, nevertheless, quite similar 
in essential points, so that change of climate need not be considered 
in discussing the morbidity of the tribe, particularly that due to 
tuberculosis. The reservation is, for the most part, gently rolling 
in the south, and broken and hilly farther north, while the north- 
western portion presents, on an extensive scale, the characteristic 
barrenness of the Bad Lands. There are no mountains. The aver- 
age altitude is somewhat more than 3,000 feet. Though there are no 
forests, scattered pines are found on the ridges, and other trees 
along the waterways. The soil on the elevations is sandy or gravelly 
and for the most part barren, but the valleys along the creeks and 
rivers are filled with fertile silt. Water is not abundant, there 
being no large rivers and only a few small shallow lakes. Drinking 
water is obtained mainly from the creeks and from springs; it is of 
fairly good quality, containing little or no alkali. 

The annual precipitation averages about 25 inches, but varies 
much in different places and seasons. There are no fogs, and dew 
is observed but seldom. Snow is rarely deep, except in drifts. 
The country is hot in summer, when the thermometer rises occasion- 
ally above 100° F., and cold in winter, the mercury falling as low as 
40° below zero. The nights, as a rule, are cold, even in summer. A 
strong breeze usually prevails, and there are occasionally high winds. 

In regard to civilization, the Oglala are in the transition period, 
which generally means partial degeneration. They live in small or 
fair-sized log houses of one room, each provided with one or two small 
windows that are never opened. The houses have earthen floors and 
sod roofs. In summer almost every family constructs from poles 
and boughs, or from young pine trees, a more or less open shelter 
in which, while it is warm, they spend most of their time. 
Usually, each family has also a light, easily portable tent, wmich rep- 
resents the ancient tipi. These tents are erected near the house 
and are occupied by the aged, by some relative or visitor of the 



12 



BUKEAU OF AMERICAN ETHNOLOGY 



[BULL. 42 



family, or serve to sleep in. When the family leaves home, such a 
tent is packed, together with bedding, kitchen utensils, etc., into 
the wagon, and is pitched whenever a stop is made for the night. 
Indeed, there will be at times one or more villages of these tents 
near the agency, or about a house where some particular feast is 
being given. In summer these tents are oppressively hot during the 
day, though they become cool if the sides are raised. As they are 
made of very light fabric, they are cold at night, and afford but poor 
protection during a severe rain or hail storm, as the writer person- 
ally experienced. (Pis. 5-9.) 

The dwellings of the various families are generally isolated and 
in many localities far apart. Along the creeks and rivers they dot 
the low elevations. In fair weather, especially in the daytime, 
there is no lack of fresh air, even in the log houses. When it becomes 
cold, however, the families retire to their log structures, close all 
apertures and crevices, and make fires. In this confined and over- 
heated atmosphere they spend a large portion of their days and nights, 
without ventilation other than that caused by the opening of the door 
as some one enters or leaves. There will be, at times, a dozen or 
more persons in a room under such conditions. However, the most 
dangerous features about these dwellings are the earthen floors 
and the general uncleanliness of the people. The earth of the floors 
is but little solidified. The healthy, as well as the sick, among 
whom are consumptives, expectorate freely on these floors, covering 
their sputum usually with a pinch of earth. In this manner the 
floors are probably all infected with the tubercle bacillus. Even if 
the family itself should be healthy, it is sure to be visited eventually 
by consumptives who distribute the infection. The dry, fine dust 
of the floor readily floats in the air, where it is inspired by children 
as well as adults. This is doubtless one of the principal causes of 
the spread of the disease on this reservation. Besides this, the fur- 
nishings of the dwellings, as blankets, bedding, bags and woolen 
clothing, are generally found to be more or less filthy. Many such 
articles come in direct contact with the floor and, especially in houses 
where there are consumptives, become, in course of time, soiled with 
infected dirt or sputum. The dust from such articles is undoubt- 
edly dangerous to health. 

As to clothing, the Oglala now dress like the whites in most 
respects, though the majority still persist in wearing moccasins. 
The women wear leggings and always a blanket or shawl when going 
about. A tendency to wear too much clothing, even on the hottest 
day, was again noticed and is very prevalent. This is due partly to 
ignorance and partly to vanity. The garments are usually far from 
clean. The writer learned of several instances in which the clothing 
of tuberculous persons was given or sold to others. 



hrdliCka] TUBERCULOSIS AMONG CERTAIN INDIAN TRIBES * 13 

In diet the Sioux are chiefly meat eaters, the principal kind of 
meat consumed being beef. They cook this fresh or cut it into strips 
and dry it on cords stretched outside their dwellings. Other com- 
mon articles of diet are badly made wheat bread and large quantities 
of coffee. When they have money they purchase crackers and 
canned foods. They eat very irregularly, both as to time and quan- 
tity. During feasts and when visitors are present they not infre- 
quently use the same wooden spoon or other utensil, one after another, 
and eat from the same dish, the bones and other remnants being 
freely strewn over the floor. 

In many of the dwellings it was seen that the denizens lack in both 
quantity and quality of food on account of their poverty. This 
affects the adults, especially the aged, more than the children. 
Numerous cases were seen where the whole meal consisted of a few 
crackers and black coffee. In several instances cattle which had 
died of disease had been consumed, both flesh and viscera. Accord- 
ing to the resident physician, Doctor Walker, the Oglala eat not 
only cattle but even horses and dogs that die of disease. The 
people are not emaciated; in fact, many look well nourished. Yet 
there is no doubt that many do not receive, except on rare occasions, 
all the nourishment they require. This doubtless induces indolence 
and disease. It would also strongly promote the spread of alcohol- 
ism, but fortunately there are very few chances for obtaining liquor 
on or near the reservation. 

Few of the Oglala men have any steady occupation. They do 
very little farming. During the summer they cut some hay in the 
valleys, which brings fair prices. Cattle and horses are being dis- 
tributed by the Government to the different families, and stock 
raising is being encouraged with some success. With certain families 
it already constitutes an important item of sustenance. This occu- 
pation affords the men, and also some of the boys and girls, much 
needed exercise of the best kind. A small percentage of the men 
are employed about the agency and school, while others go off the 
reservation to theaters and circuses, or for other employment. The 
women are occupied almost exclusively with housework. Notwith- 
standing these opportunities for working, many men in the tribe were 
seen by the writer to be idle. Of these, many were traveling in their 
wagons in a seminomadic fashion, bent mostly on visiting; this is 
not, of course, a desirable condition from the sanitary point of view. 

The people of this tribe are quite shrewd, tractable, and glad to be 
instructed, though the instruction given does not always have prac- 
tical results. Their most striking peculiarities are the above-men- 
tioned tendency to a seminomadic life and the disinclination to steady 
manual work. They are very ignorant of all matters regarding 
hygiene. One of the most reprehensible customs among them is the 



14 



BUREAU OF AMERICAN ETHNOLOGY 



[bull. 42 



so-called "passing of the pipe." Whenever a number of men have 
gathered in a house, there is passed from mouth to mouth a lighted 
pipe, the mouthpiece of which is never cleaned. As there is often 
in such a group an individual in the earlier stages of consump- 
tion, the habit must be regarded as providing a direct mode of 
infection with the disease. 

Drunkenness is infrequent on the reservation, owing to the scarcity 
of liquor. 

QUINAIELT 

This small tribe, which on June 30, 1907 numbered only 141 indi- 
viduals, lives on a relatively large and thickly wooded reservation 
along the seacoast and about the Quinaielt river and lake in north- 
western Washington. The Quinaielt are a branch of the Coast 
Indians of that general region, and the data concerning them, in 
this paper, apply equally to the related groups situated farther north, 
on the peninsula. (Pis. 10, 12.) 

The Quinaielt are quite advanced in civilization. They live in 
frame dwellings, the newest of which are, both in architecture and 
furnishing, comparable with similar dwellings among us. They 
dress as do the whites, and each family is provided with various 
utensils and other articles of civilized manufacture. 

The reservation is an extensive flat, elevated but little above the 
sea, and overgrown with an almost impenetrable primeval forest, in 
which spruce and hemlock predominate. The Indians are settled in 
a village (pi. 11) at the mouth of the Quinaielt river, and in scattered 
dwellings along this river and about Quinaielt lake. The village 
consists of about twenty frame houses, built close together, but with- 
out crowding. On account of the immense amount of labor involved, 
and because of the abundance of food in the water, the Indians have 
cleared but little of the land, and cultivate this on a very limited 
scale. 

The climate of the region is not very agreeable. The temperature 
never rises high, nor does it fall very low, but the air is often chilly 
and raw, even in summer. The summers are rainless, but many of 
the days are foggy, 'and on such days the mornings and evenings are 
unpleasantly cold. From September to Ma} r or June is the rainy 
season, during which precipitation is very frequent and abundant, 
the average rainfall being usually well above 100 inches. During the 
winter there are occasional severe windstorms. There is but little 
snow, and this does not remain long. Frosts are rare and light. The 
amount of sunshine which the Quinaielt receive in the course of the 
year is decidedly below the average. The sea water is cold the whole 
year. 

The Quinaielt are domestic, mild-mannered, and tractable. The 
men of the tribe are almost exclusively fishermen. They depend par- 
ticularly on the annual run of the highly valued Quinaielt salmon, 



hrdlicka] TUBEKCULOSIS AMONG CERTAIN INDIAN TRTBES 15 

catching them by means of seines in the river, which is partitioned 
for this purpose among the various families. They catch also an 
abundance of smelt in the surf about the mouth of the river. These 
are taken with a hand seine, fastened to a small pole, the Indians 
wading barelegged into the cold surf and getting wet and chilled. 
Most of the fish caught, particularly the salmon, are readily sold at 
fair prices. The people clear annually from several hundred to more 
than a thousand dollars per family for the salmon alone. Consider- 
able quantities of smelt are also sold. With the money thus obtained 
the people buy a portion of their food, their house furnishings, and 
not infrequently luxuries (gramophones for example) . No cows are 
kept in the tribe, but all have w^agons and the necessary horses. 

The women, besides being occupied with their housework, make 
many decorated baskets, which are sold to tourists. As the demand 
for these is always greater than the supply, they derive from this 
source an important addition to their incomes. (PI. 12.) 

The food of the Quinaielt consists principally of fresh, dried, salt, 
and smoked fish. No evidence of actual want was seen in any of the 
houses, but there is more or less irregularity about meals, which are 
not properly prepared. Salt fish seen on some tables smelt so bad 
that one unaccustomed to such diet would be unable to eat it. Rem- 
nants of food, some of which are to be utilized at the next meal, are 
exposed for a long time on the table, regardless of the flies. In every 
house the members of the family, including the sick, expectorate 
freely on the floor, only exceptionally using a tin can for the purpose. 
The flies feed very largely on the sputum, and there is certainly a 
great deal of infection carried by them to the food left on the table. 
This feature undoubtedly has a bearing on the morbidity of the peo- 
ple. As in their houses, so also in their persons — they are deficient 
in cleanliness without being actually filthy. They have apparently 
only the most elementary ideas of hygiene. The sick are not isolated 
in any way, and consumptives live in the midst of their families and 
work as long as they can. A woman, far advanced in the disease, 
coughing and expectorating very frequently, was seen in one of the 
houses making baskets for tourists, and doubtless this was not a very 
exceptional case. As their manner of making these baskets requires 
the wetting of the fibers in the mouth, and as there is no subsequent 
disinfection of the basket when finished, doubtless not a few of those 
sold to tourists carry abundant and dangerous infection. 

The treatment of the sick in this tribe is very defective. The 
tribe being small and isolated, there is no agency physician, and no 
other white physician within a distance of many miles. As a result, 
medical help depends very largely upon the abilities and supplies of 
the resident teacher and of the two or three native medicine-men. 
Under such circumstances but little can be done against the spread 
of tuberculosis. 



16 



BUREAU OF AMERICAN ETHNOLOGY 



[bull. 42 



Hupa 

Th? Hupa, 426 in number, occupy a narrow but beautiful and 
fertile valley, 350 feet above sea level, in northern California. The 
valley is divided throughout its entire length by the Trinity river, 
and is surrounded by thickly wooded mountains of moderate height. 

This region is hot in summer, the temperature in the daytime often 
exceeding 100° F. in the shade. In winter it is chilly and wet. The 
evenings and nights are always cool. There are well defined dry and 
rainy seasons. The latter season lasts from November to April, and 
the precipitation is very frequent, as well as abundant. Occasionally 
there is a slight fall of snow, which, however, does not remain longer 
than a few hours. The latter part of the winter is unpleasantly 
chilly, and favorable to the development of tonsilitis, rheumatic 
disorders, and especially catarrhal affections of the respiratory tract. 

More than one-fourth of the Hupa show admixture with whites. 
Among the pure-bloods there are individuals who came from rem- 
nants of other tribes in the neighborhood. The Hupa are well 
advanced toward civilization, particularly the younger element. 
Almost all understand English, and many speak it. They live in 
frame houses, built like those of the whites, with plenty of windows, 
and containing generally more than one room. The houses are 
heated, as a rule, with modern ranges, only two of the old ones 
having been found with open fireplaces. Earth floors are seen in 
only a few of the oldest homes. In a majority of cases the houses 
were found both well ventilated and fairly clean. Squalor prevailed 
only in a few of the poor dwellings and in those occupied by the 
aged, some of whom were too debilitated to be able to give proper 
care to their rooms. The dwellings (pis. 13-17) are generally isolated, 
though in a few localities in the valley they are grouped. This is 
particularly true of the "Captain John's Camp" (pi. 17), occupied 
by old people and by others who are poor; but in no case are the 
dwellings at all crowded. Most of the houses are surrounded by 
gardens and orchards, with fields or woods beyond. 

The Hupa dress like the whites, the only exception being the 
basket cap, which is still worn on the head by the old women. Here 
also was noticed, however, a tendency to wear more clothing than 
the season required. 

By occupation the people are principally farmers, every family 
possessing and utilizing an allotment of good land in the valley. 
They farm according to civilized methods and meet with a fair 
measure df success, raising mostly oats, but also quantities of brown 
beans, potatoes, wheat, corn, and hay, for which there is a good 
market at the school. The orchards furnish plenty of fruit, particu- 



hrmjCka] TUBERCULOSIS AMONG CERTAIN INDIAN TRIBES 17 

larly plums and apples; and in season the women gather quantities of 
acorns, preparations made from which are much liked by these people. 
Most of the families possess horses and wagons, but there are only a 
few cows on the reservation. A majority of the families keep also 
chickens and raise pigs. In the spring there is fishing, when the 
Hupa catch a great many eels and a limited number of salmon. Since 
the establishment of salmon canneries near the mouth of the river, 
few of the fish reach as far up the stream as the valley. The men also 
hunt in the valley and in the surrounding mountains, killing quail, 
rabbits, deer, and bear. The meat of the bear, however, is not 
eaten. A certain number of the Hupa men are employed by whites 
at the government school and also outside of the valley. As a result 
of these activities, there is usually but little want in the tribe, except 
among the aged, the sick, or the dissipated. About thirty of the old 
people receive biweekly limited rations from the Government. Never- 
theless, there is no steady supply of nourishing, properly prepared, 
and regularly served food as there is among the whites living in the 
same region. 

In their general habits the Hupa are domestic and less improvi- 
dent than are numerous other tribes. They are intelligent and 
approachable. Drunkenness is infrequent. However, they still 
know very little concerning hygienic living. They do not take suffi- 
cient care against exposure to wet and cold, and they have no ideas 
about the prevention of sickness, particularly consumption. They 
still use basket bowls for soups, passing them freely to well and sick 
alike. These baskets are never properly cleaned and surely furnish 
one means of spreading tuberculosis. 

Mohave 

The Mohave are divided into two main groups, one settled about the 
Needles, Cal., and Fort Mohave, Ariz., in part reported by the writer 
in Bulletin 34 of the Bureau of American Ethnology, while the other — 
formerly the main body of the people — lives on the reservation along 
the Colorado river, 2 miles south of Parker, Ariz. The following 
notes apply to this latter group only. 

The Colorado River Mohave number 465 individuals. They are, 
with few exceptions, of pure blood. Their reservation is of moderate 
size and is located in a part of the region where they have dwelt since 
ancient times. The land is covered with willows, cottonwoods, and 
mesquite along the river, but assumes a short distance from it the 
semidesert character of the surrounding country. The ground is 
flat and low, and a narrow strip near the river is subject to annual 
overflow. The soil is of fine sand and silt adobe, quite barren, but 
fertile when irrigated. 



18 



BUREAU OF AMERICAN ETHNOLOGY 



[bull. 42 



The climate is dry and warm. The summers are very hot, the 
mercury reaching, on some days, as high as 118° F. The nights 
during this season are warm, necessitating sleeping in the open. 
The winters are usually dry, delightful in the daytime and cool at 
night, without snow or frosts. In February and March and occa- 
sionally during the summer there are showers, but these are seldom 
heavy. 

As to civilization, these people are in the transitional period. 
While clinging to their old habits, and living largely as they did 
before the advent of the white man, they nevertheless wear clothing 
similar to his, buy his household utensils, bedding, etc., possess 
horses arid wagons, and follow him in other particulars. Their 
dwellings (pis. 18-22) are mostly large, well-made shelters, open on 
all sides, a mere frame of cottonwood posts and poles, supporting a 
roof of brush. In addition to these, a number of families have fairly 
substantial brush-adobe houses, used chiefly in the colder weather. 
All of the Mohave dwellings have floors of earth or sand. In the 
open shelters the warm, soft sand, when cleaned from all large par- 
ticles by sifting, is suitably hollowed and used for a bed, particularly 
by the old people. It is also the playground of the little children. 
Yet this sand is at the same time the receptacle of remnants of food, 
of the expectorations of sick and well alike, and of filth from the 
chickens, all of which look diseased. 

As already mentioned, the Mohave dress quite similarly to the 
whites. The calico dresses of the women are, however, of their own 
picturesque design, and moccasins are worn by the older people. 
During the summer young children and old men are often seen nude. 

The Mohave men have no steady occupation. They make small 
plantings of corn, beans, and melons on a few clearings near the river 
and work at times on the irrigating ditch operated by the Government. 
So far, however, neither the farming nor the irrigation has proven 
very successful. Rabbits, quail, large mice, and occasionally water- 
fowl are hunted to some extent, and the families living nearest the 
river catch some fish. When opportunity offers, the able-bodied men 
work for the whites, but the occasions are not common. 

In addition to doing housework, the women collect large supplies of 
native foods in season, particularly the mesquite beans and screw 
beans. They gather also young cactus leaves, cactus fruits, and nu- 
merous native seeds. The older women, in addition, make consider- 
able beadwork for sale to the whites. 

The diet of the Mohave consists of the above-mentioned native and 
cultivated articles, also of fish, meat, and wheat tortillas, together 
with crackers and canned fruits, which are purchased from the store. 
Mesquite beans and screw beans are collected in large quantities, cured 



hrdlicka] TUBERCULOSIS AMONG CERTAIN INDIAN TRIBES 19 

in the ground, by a certain process, and stored in great coiled baskets. 
They are cooked whole, or are ground and made into heavy, but sweet, 
nourishing bread. Meat is scarce. There is a native butcher from 
whom they purchase fresh- or jerked beef when they have money. 
Cattle and even horses which have died from disease are eaten. Only 
one family keeps cows. Chickens are seen around every dwelling, 
but they are as poor and sickly a lot as could be found anywhere. 
Every family keeps several poor dogs, sometimes eight or ten, one of 
which is occasionally eaten. In common with the chickens the dogs 
act the useful part of scavengers. The old people on the reservation 
receive limited rations every two weeks from the agency. All things 
considered, poverty and want are more frequently witnessed in this 
tribe than in any of the others that were visited, with the exception 
of the Sioux. Their food supply is irregular; while some meals that 
the writer saw were tasty, nourishing, and plentiful, in many other cases 
meals were insufficient for proper nourishment. The natives best off 
in this respect are those who live at a distance from the agency, on 
clearings near the river. 

In their habits the Mohave are domestic, though they are fond of 
traveling and visiting. They are mild-natured and approachable, 
and not averse to work, though under the present circumstances there 
is considerable idleness among the men. They are generally ignorant 
of hygiene, and in their homes there is frequently more or less squalor. 
Bedding and heavy articles of clothing are never washed. Food in 
general, especially meat that is being dried, is much exposed to flies. 
Personal cleanliness is imperfect. However, the boys are fond of 
bathing in the muddy river, and the girls like to wash their heads in 
the seepage water from the shallow wells. The sick and the aged are 
often neglected, and the rations which the latter receive are to a large 
extent consumed by their relatives. 

Drunkenness is infrequent, owing to scarcity of liquor. 

In the following pages are tabulated, for ready reference, the 
principal data concerning the five tribes studied. 



20 



BUREAU OF AMERICAN ETHNOLOGY 



[bull 42. 



II 



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HRDLICKA] 



TUBERCULOSIS AMONG CERTAIN INDIAN TRIBES 



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111 
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03 M 

CD .tS 



CD 



: 5 g 4 
o 
X 



a .2 g 



ft. 3 



■ts f i 
ft a £ s 



i - 

| 03° 

° 

c3 



22 



BUREAU OF AMERICAN ETHNOLOGY 



[bull. 42 



Yet, notwithstanding the many differences shown in the preceding 
table, all the tribes visited suffer from tuberculosis in its several 
forms (except perhaps lupus) in quite constant proportions and to a 
much greater extent than the whites living in the same regions. This 
indicates that none of the above conditions can be regarded as of 
paramount importance in favoring the spread of tuberculosis among 
the Indians. 

We come now to the Indian school at Phoenix. This school is a 
type of the large, advanced, nonreservation schools for the Indians. 
It receives pupils of both sexes, and of all ages from later childhood to 
advanced adolescence. As in all institutions of this nature, the 
pupils are obtained from various reservations through solicitation 
by the agents of the school. According to the present system of 
appropriations, the greater the number of scholars in the school the 
greater its allotment, the actual return for each scholar amounting to 
considerably more than $100. 

The capacity of the Phoenix school is upward of 1,000 pupils, but 
to approximate this number would mean crowding. The institution 
is situated in the midst of the originally desert flats west of Phoenix, 
3 J miles from the city, and equally distant from the nearest hills. 
The grounds of the school are limited in extent and are surrounded 
on all sides by private lands, many of which are built upon. This 
situation is not favorable to much outdoor exercise and recreation 
for the children. Besides this, some of the settlements in the neigh- 
borhood are occupied by consumptives. In fact, the district in 
which the school is situated is, as a whole, a Mecca for consump- 
tives, particularly in winter, when the number of such patients in 
the valley reaches into the thousands. 

The climate is that of the lower plains of southern Arizona, save 
that the effects of the heat during the long summer are intensified by 
the increased humidity due to widespread irrigation. The supply of 
drinking water is not of the best. On this account the school has a 
large distilling plant which provides almost all the water used. 

The school buildings, including the workshops, were found to be 
roomy and well kept, and the class rooms leave little to be desired. 
The drainage, however, especially in the boys' dormitory, is very 
defective. The difficulties in this respect are due mainly to the 
level character of the country. Among the accessories of the school 
are a building originally devoted to gymnastics, which has now fallen 
into disuse, and a fine, large swimming tank which lacks the impor- 
tant requisite of an adequate supply of running water. The water 
is changed only once a week. The first day after the tank is filled the 
employees bathe; next come the girls, and during the remainder of 
the week the tank is used by the boys. It is in great favor with 
the children, whose enjoyment of the water is augmented by simple 
gymnastic apparatus placed over the tank. But, of course, the water 
soon becomes polluted. It then contains, besides other body emana- 



hrdlicka] TUBERCULOSIS AMONG CERTAIN INDIAN TRIBES 23 



tions, what lias been washed and ejected from the noses and throats 
of those using the tank. As the water naturally enters the nasal and 
buccal cavities of the bathers, besides being sometimes swallowed, it 
must be regarded as dangerous to the health of the pupils. 

The clothing of the children is sensible and comfortable. It is, 
however, so uniform that it can have but little pleasing or stimulating 
effect on their mentality. 

According to the disciplinarian of the institution, the duties of 
the children in the Phoenix school are as follows : 

Rising time, the whole year round, 5.35 a. m. Ten minutes for 
washing and dressing. 

5.45 a. m. children are supposed to be in line. Roll call five to 
ten minutes' duration. 

5.55 a. m. ssmimilitary drill; boys every morning, girls every 
other morning; no special duty for the girls during this time on days 
when free from drill. The drill lasts until 6.15 a. m. There is no 
regular drill during the summer vacation. 

6.15 a. m. flag-raising ceremony. 

6.30 a. m. to 7 a. m. march to breakfast and breakfast. 

7 to 7.30 a. m. rest and dressing for work or school. 

Working hours 7.30 to 11.30 a. m. and 1 to 4 p. m. During vaca- 
tion 1 to 3 p. m. School hours 9 to 11.30 a. m. and 1 to 4 p. m. 

Children of each sex are grouped; those who work in the morning 
go to school in the afternoon, and vice versa; and this order is re- 
versed each month. 

11.45 a. m. until 12.15 p. m. march to dinner and dinner. 

12.15 to 12.50 p. m. change of clothing for those who work. 

12.50 p. m. work and school call. 

4 to 5.15 p. m. free, for those in school and for some of those who 
work. 

5 to 5.15 p. m. time for washing, for those who were at work. 
5.15 to 5.45 p. m. march to supper and supper. 

5.45 to 7 p. m. free, except for those who are employed at neces- 
sary occupations. 

7 to 8 p. m. night school, every week day except Thursda}^. On 
Thursday the matron and the disciplinarian have charge of the chil- 
dren and give them talks on topics in their lines. 

8 to 8.20 p. m. free. 

8.20 p. m. roll call, following which all go to their rooms, or dor- 
mitories, undress, lie down, and talk. 

9 p. m. all talking must stop; lights go out. 

Sundays are somewhat less strenuous. There is an inspection of 
about one hour's duration in the morning; then one hour of Sunday 
school; then dress parade, and change of uniform. In the after- 
noon there is from an hour to an hour and a half of church, the 
rest of the time being free; in the evening, from 7 to 8, singing of 
religious songs. 



24 



BUREAU OF AMERICAN ETHNOLOGY 



[bull. 42 



During midsummer children over 12 years of age get thirty days' 
vacation; under 12 years, sixty days. Those whose homes are far 
away ; and some exceptional cases, remain at the school the entire 
summer. During the writer's visit there were at the school 125 
boys and 95 girls who were without vacation. 

According to the girls' matron, freedom beyond that allowed by 
the rules, is afforded the girls whenever possible; this is left largely 
to the discretion of the matron. 

During the free intervals the children walk about the grounds of 
the school, or sit under the palms, and some scatter over the near 
neighborhood. 

Statistical Data for Tribes Visited 

In recording the cases of tuberculosis found in the tribes described 
above, subjects having pulmonary symptoms were divided into those 
in whom the presence of tubercle bacilli, or the physical condition 
and history of the patients, allowed no doubt as to the nature of 
the disease, and those as to whom the diagnosis was not entirely cer- 
tain. Scrofulous glands were classified under three heads, namely: 

(1) Had suppurated, but were now healed. 

(2) Suppurating when observed. 

(3) Had not suppurated. 

Under the last heading were included only those in whom the 
enlarged glands were visible. The number of cases in which some 
enlargement was perceptible is much greater, but not possible of 
exact determination. Cases in which the person examined, or his 
relatives, gave a history of enlargements which had not suppurated 
and w?re no longer perceptible, had to be excluded from the statis- 
tics; for, on closer questioning, it was often found that the enlarge- 
ments were of other than scrofulous nature, while in other instances 
their character remained uncertain. 

Table 4. — Results of examination (1908) of family groups 



Data obtained. 



K 6 
o > 

P 



Number of family groups examined 

Number of deaths from tuberculosis c 

from pulmonary tuberculosis 

per 1,000 of population 

Number of individuals in family groups examined 

male 

female 

Number of cases of phthisis positively established 

percentage of cases examined 

male 

percentage 

a Examination in July. b Examination in August. 



100 
12 
11 
8.0 
403 
197 
206 
16 
4.0 
8 

4.1 



100 
67 
51 
12.4 
428 
200 
228 
21 
4.9 



87 
6 
4 

9.4 
331 
153 
178 
9 

2.7 
4 



4.5 

c During fiscal year 1907-8 



79 
7 

6 

12.5 
357 
185 
172 
15 
4.2 
7 

3.8 



hrdliCka] TUBERCULOSIS AMONG CERTAIN INDIAN TRIBES 25 



Table 4. — Results of examination in 1908 of family groups — Continued 













iver 


Data obtained. 


minee 


a Siou 


2 




ado R 
ohave 




o 




a 


C3 
ft 






g 


"So 






0 






O 


0? 


w 


O 


Number of cases of phthisis positively established— Continued. 












female 


8 


12 


2 


5 


8 


percentage : 


3.9 


5.S 


6.1 


2.8 


4.6 


acute 


1 


0 


0 


0 


0 


percentage 


6.0 


0.0 


0.0 


0.0 


0.4 


subacute 


3 


5 


0 


3 


0 


percentage 


19.0 


24.0 


0.0 


33.3 


27.0 




12 


16 


3 


6 


11 


percentage 


75.0 


76.0 


100.0 


66.7 


73.0 


distribution according to age- 












adults (above 20) 


14 


17 


2 


5 


13 


percentage 


77.8 


81.0 


66.7 


55.6 


86.7 


adolescents (14 to 20, inclusive) 


2 


2 


1 


3 


1 


percentage 


11.1 


9.5 


33. 3 


33.3 


6.7 


children (under 14) 


2 


2 


0 


1 


1 


percentage 


11.1 


9.5 


0.0 


11.1 


6.7 


Number of cases indicating phthisis, but admitting of doubt.. . 


20 


34 


5 


20 


10 


male , 


8 


16 


2 


10 


2 


female 


12 


18 


3 


10 


8 


Number of cases of tuberculosis of neck glands 


48 


43 


3 


40 


26 


a had suppurated 


31 


25 


1 


21 


18 


b suppurating 


3 


7 


0 


6 


3 


cases of a and b together per 1,000 examined 


84-4 


a74-8 


16.1 


81.6 


58.8 


c had not suppurated 


14 


11 


2 


13 


5 


Number of cases of tuberculosis of bones 


5 


9 


0 


5 


4 


healed 


3 


6 


0 


4 


1 


active : 


2 


3 


0 


1 


3 


Number of individuals free from suspicion of phthisis and 












other forms of tuberculosis 


316 


323 


50 


257 


315 


percentage of cases examined 


78.5 


75.5 


8L0 


77.6 


88.2 


Number of family groups free from suspicion of phthisis and 












other forms of tuberculosis 


40 


34 


6 


30 


46 


percentage of family groups examined 


40.0 


34.0 


40.0 


34.5 


58.2 



a Per 1,000 of population. 



As to the Phoenix school, among the 220 children present there 
were 2 positive cases of phthisis of subacute form and 5 suspicious 
ones. A number of pupils who showed signs pointing to tubercu- 
losis of the lungs were sent home during the current year. How 
some of the children succumb to the disease will be shown from the 
following illustration, for which the writer is indebted to the school 
physician. In November, 1907, there were brought to the school 28 
new Papago pupils, an examination of whom showed that they were 
in good health. Before July, 1908, 5 of these pupils had already 
been sent back to the reservation on account of serious illness, 
pointing to tuberculosis. Two of those sent home have since died 
71530— Bull. 42—09 3 



26 



BUEEAU OF AMERICAN ETHNOLOGY 



[BULL. 42 



of consumption. Two others of the same group of 28 children are 
among the above-mentioned 5 suspicious cases, showing a gradual 
failing, with slight cough. 

From the above tables it is seen that the cases of phthisis positively 
established in these tribes amounted to from 3 to 5 per cent of their 
whole population — an appalling proportion. In addition to this, 
large numbers, particularly of the young, had at the time of exami- 
nation, or had had in the past, tuberculosis of the cervical glands or 
of the bones. Among the Indians the pulmonary form generally 
involves both sexes in nearly equal proportion; nevertheless, all of 
these tribes show a slightly greater frequency of the infection in the 
females. This presents a contrast to the case of the American whites,, 
in whom the males are the greater sufferers. 

As to the ages of the patients, it is seen that a large majority of the 
afflicted were above 20. A much smaller proportion of cases was 
found in children under 14 years of age, as was true also of those 
between 14 and 20. If, however, similar statistics were gathered 
during the latter part of the winter and in the early spring, the 
proportion of adolescents and young adults attacked by the disease 
would probably be higher than that of the children or than that of 
the adults in excess of 35 years of age. For at that time of the 
year would be found a greater number of acute cases, which appear 
mostly in subjects between 16 and 35 years of age, and the majority 
of which before the advent of summer have been eliminated by death. 
Again, if tuberculin tests could be applied to the children it is very 
certain that a larger proportion of cases would be found in this group. 
Considering the adults alone, it was found that a greater number of 
cases of pulmonary tuberculosis existed among those in early and late 
adult life than among those between 35 and 55 years of age. In all 
these conditions among the Indians as compared with the whites no 
radically different features exist. 

The cases in which positive diagnoses of phthisis could not be 
established, and which therefore are classed as doubtful, embrace, in 
all probability, instances of bronchitis of long duration, due to other 
causes than tuberculous infection. But they certainly include also 
cases of pulmonary tuberculosis of mild or very irregular character 
or encountered in the early or late stages of the disease. It is well 
known that under the latter conditions the tubercle bacillus is often 
absent from the sputum, or can be detected only after repeated exami- 
nations. Some of these doubtful cases presented many symptoms 
and some physical signs of pulmonary tuberculosis, yet, in addition 
to a negative sputum examination, other distinguishing features were 
absent, necessitating a reserve in diagnosis. 

As to the varieties of phthisis encountered, the tables show but one 
truly acute case. As has been mentioned, such cases occur princi- 
pally during the winter and spring and terminate in death or become 
subacute or chronic before midsummer. Some of the acute cases 



hrdliCka] TUBERCULOSIS AMONG CERTAIN INDIAN TRIBES 27 

formerly seen by the writer among the Indians, and others of which 
he learned personally on the reservations, are of very rapid course, 
terminating within a few weeks or two or three months. Subacute 
cases, with more moderate symptoms and a duration beyond three 
months, were well represented in all of the tribes. A decided majority, 
however, of the cases of consumption encountered were of the chronic 
type, with slow and irregular progress, and in man} r instances of more 
than a year's duration. Such cases often show a tendency toward 
recovery, and in every locality more than one individual was met 
with in whom symptoms of the disease, after lasting for years, had 
been followed by complete recovery. The subacute cases often 
become chronic and may progress to recovery. In many more 
instances, however, judging from past experience and the informa- 
tion obtained during the investigation here dealt with, such cases 
become aggravated and speedily result in death. 

Tuberculosis of the cervical glands has been observed among the 
Indians in individuals of all ages, from early infancy to middle age. 
The youngest patient seen with this disorder was a girl one year old, hi 
whom the glands had already suppurated. The oldest cases were 
two women, each about 45 years of age, and another woman who gave 
her age as 46. In the two former the swollen glands were clearly 
tuberculous, though not yet pointed; there were at the same time 
other signs of tuberculous infection, one being classed with the 
positively established cases of phthisis, the other with the doubtful. 
In the woman of 46 the glands were still suppurating, while lung 
symptoms indicated, at the same time, chronic consumption. Among 
the Mohave two moderately enlarged cervical glands, not suppurat- 
ing, were seen in an old man about 85 years of age. The nature of 
these swellings could not be exactly determined, but the patient, 
whose sputum contained tubercle bacilli, had, so far as could be ascer- 
tained, no other disorder which might account for the glandular 
enlargements. 

In the Indian tuberculosis of the bones usually attacks the spine, 
hip joint, ribs, or tibiae. One case was seen in which the wrist was 
involved, and another in which a discharging sinus led to either the 
malar bone or the malar process of the, superior maxillary bone. 

Of the other forms of tuberculosis, it was found that in the T'oung 
children the disease is especially apt to manifest itself in the meningeal 
form. Intestinal tuberculosis seems to appear only as a complica- 
tion of tubercular process in other parts of the body. 

The prevalence of tuberculosis in its various forms, among the 
tribes visited, is especially illustrated in the last two items in the 
tables, giving the proportions of individuals and of family groups 
totally free from any suspicion of the disease. Such family groups 
among the full-blood Oglala fall as low as one-third of all of those 
examined. In at least two-thirds, then, of the families of the Oglala 
Sioux there are some indications of tuberculous infection. 



28 



BUREAU OF AMERICAN ETHNOLOGY 



[BULL. 42 



V. SYMPTOMATOLOGY 

The symptoms manifested by tuberculous Indians are much like 
those seen in similar cases of the disease among the whites. Yet 
there appear to be a few interesting differences, and more detailed 
future studies may possibly establish others. 

The rapid cases are characterized by all of the well-known symp- 
toms of galloping consumption. The fever, sweats, and a rapid ex- 
haustion of the patient are especially noticeable in the Indian. 
Emaciation in these cases is not extreme, while hemorrhages are 
liable to be profuse. Fatal termination is almost the rule. 

The subacute, and especially the chronic cases, show, as among the 
whites, a gradual emaciation, with loss of strength; cough, annoying 
at night and especially in the morning; feverishness, particularly 
toward evening or night; hemoptysis; night sweats, and also more 
profuse sweating during the day. The feverishness is mostly irregu- 
lar, and in some cases the patients complain more of chilliness than 
of heat. Expectoration is so scanty in some instances that it requires 
more than a day to obtain a fair sample of the sputum, while in other 
cases it is profuse. Hemoptysis seems to be the rule, but in these 
slower cases is rarely profuse. Subjective pains and tenderness on pal- 
pitation are present in all cases, though they are seldom of more than 
slight to moderate severity. Pain on pressure is especially noticeable 
in the interscapular region, along both sides of the spinal column. 
Pressure o^er the apices of the lungs is also painful, and occasionally 
there is hypersensitiveness here on percussion. The finger tips of 
many of these patients become clubbed, as in white consumptives; 
the supraclavicular, subclavicular, and intercostal spaces sink in, 
while the clavicles and scapulae protrude. General but not excessive 
emaciation is met with. 

On auscultation it is found that the upper lobes — right and left 
in about the same proportion — are generally affected first, and that 
they always suffer more than the lower. There are prolonged and 
audible expiration; sharp, harsh or hard inspiration; moist or crepi- 
tant, diffused or localized rales, and pronounced bronchophony over 
the infected areas. Occasionally there are plain signs of a cavity. 
In very old cases, where extensive fibrous changes have doubtless 
taken place, respiratory sounds over the apices may be quite audible. 

In the chronic forms of pulmonary tuberculosis in the Indians, 
percussion is quite unsatisfactory. In a great majority of the 
cases there is an absence of pronounced dullness. Among the 
many chronic cases examined there was no instance in which the 
dullness of the affected lobes was as marked as that which is found in 
normal conditions, over the heart or liver. In numerous patients, 
where the presence of the bacilli in the sputum confirmed the diag- 



HedliCka.] TUBERCULOSIS AMONG CERTAIN INDIAN TRIBES 



29 



nosis, it would have been impossible to base an intelligent opinion on 
percussion alone. There is always, however, diminished or irreg- 
ular resonance. In cases of many years' duration, and in those 
who have recovered from chronic phthisis, there is a more or less 
flat sound over the apices, or over the whole of the upper lobes, 
which differs from the dullness of consolidation. In the acute cases 
seen in former years dullness seemed to be manifested to a greater 
degree. 

In a large proportion of the more severe cases of consumption a 
secondary infection of the larynx is noticeable, and is attended by 
all the well-known symptoms of that complication. 

The actual beginning of pulmonary tuberculosis is often referred 
by the Indian patients to an attack of pneumonia, pleurisy, grippe, 
"bad cold," and even measles; an insidious beginning was heard of 
less frequently. 

The bacteriological examinations made during the investigation, 
while revealing interesting conditions in special instances, did not 
indicate the existence of any peculiar racial features. It is possible, 
however, that more numerous and elaborate examinations may 
show some peculiarities in the pulmonary excretions of the Indian 
consumptive. 

As a rule, the cases of tuberculous cervical glands in the Indians 
run a mild course. In some individuals the swellings, after attain- 
ing certain proportions, gradually diminish in size until they become 
scarcely palpable. Suppuration is occasionally aggravated by a 
secondary infection, due to uncleanliness. In rare cases the ulcera- 
tion becomes extensive; in a young Mohave woman, the sores in- 
volved the front of the neck, in an irregular manner, from the lower 
jaw down to the first rib. The scars left by suppurated glands have 
the same features as in the whites. Death in these cases occurs 
only from complications. 

Nothing radically distinctive was observed in the cases of tuber- 
culosis of the bones. 

VI. ETIOLOGY 

The etiology of tuberculosis among the Indians is a subject of par- 
ticular importance. After as careful inquiry as was possible in the 
short time available, the following may be enumerated, in the order 
of their importance, as the causes of the disease, particularly in its 
pulmonary form, among these people. 

(1) The most potent of all factors is the facility of infection, partic- 
ularly during the cold or rainy season. The average Indian has no 
idea of the real nature of tuberculosis, or of the means by which it is 
propagated. He often lives in a good house, or in one that could 
easily be ventilated and kept clean. But his knowledge and habits 



30 



BUREAU OF AMERICAN ETHNOLOGY 



[bull. 42 



have not kept equal pace with the changes in his dwelling. In con- 
sequence he sees no harm in overheating his house in cold weather, and 
closing all cracks in it to prevent the entrance of cold air, destroy- 
ing in that way nearly all ventilation. He visits freely dwellings 
where there are consumptives, and is in turn visited by such patients, 
in his house. It is not uncommon to find, especially in some of the 
tribes, a closed and heated room filled with visitors, all of whom ex- 
pectorate on the floor, about the dwelling, and wherever they happen 
to go. Subsequent cleansing is always more or less imperfect, and 
thus, in the course of time, even the best dwellings are almost sure to 
become infected with tubercle bacilli. In dwellings of the less ad- 
vanced types the conditions are even worse. But the danger of 
infection from expectoration is particularly great in houses provided 
with earthen or sand floors, such as are still common among the 
Sioux and the Mohave. The healthy and the unhealthy spit freely 
on these floors, the sputum being usually covered with a pinch of 
sand or earth and thus remaining. Its removal is at best rare or in- 
complete, and often, as in the pole-and-brush shelters built on sand, 
impossible. Various articles, as bags, quilts, blankets, etc., used 
alternately by different members of the family, and occasionally given 
away, are never washed or otherwise cleaned. In the course of time 
these must bscome impregnated with the infected dust, if not soiled 
with direct expectoration, and in this way propagate the disease. 
The tuberculous are in no way isolated. They eat with the same 
utensils as the rest of the family, and these utensils are not properly 
cleansed. They sleep with others until the symptoms of their disease 
become too annoying. Their soiled clothing is in no case washed 
separately. They visit their neighbors freely, and with rare excep- 
tions they are permitted to expectorate anywhere without restriction. 
During these visits various articles, as pipes, spoons, and dishes are 
passed around, without cleaning, from the mouth of the consumptive 
to healthy mouths. Pipe passing is particularly in vogue among the 
Sioux . White consumptives come freely into contact with the Indians . 
Finally, bugles or other wind instruments and sometimes water 
cups, never sterilized, pass from mouth to mouth. Infection through 
these last-named sources is amply proven by the finding of numerous 
tubercle bacilli in most of the mouthpieces of the musical instruments 
examined on the expedition. Infection through actual contact of the 
lips need not be considered, because of the rarity of kissing among 
Indians. On the other hand, danger from utensils is greater than 
among whites, for the Indians still have here and there wooden 
spoons and basket or gourd dishes, which are more difficult to clean 
than metal or porcelain articles. All these conditions create, even 
among those Indians who live in the most modern dwellings, chances 
of infection unequaled in whole communities among the white 
people. 



hrdlicka] TUBERCULOSIS AMONG CERTAIN TNDTAN TRIBES 31 

(2) Second only to the foregoing in seriousness in the propagation 
of tuberculosis among the Indians is doubtless the now frequent 
hereditary taint among the young. In a tribe such as the wSioux it 
would be very difficult, if not impossible, to find a family in which 
there have not been tuberculous individuals, some of whose progeny 
are congenitally predisposed to the disease. 

(3) Related to the frequent hereditary taint in the Indian is his 
apparent lesser racial immunity from the disease. The existence of 
this factor seems to be demonstrated, but its exact value can not be 
determined until the Indian is observed under the same conditions of 
life as the whites. Doubtless much of what now appears to be greater 
racial susceptibility is a result of other conditions, particularly greater 
opportunities for infection, and malnutrition. 

(4) A favorable condition for the development of -the pulmonary 
form of tuberculosis, among the Indians as among the whites, is the 
presence of tuberculous glands or other tuberculous processes in an 
individual. 

(5) All exposure to heat and cold which is liable to bring on 
abnormal conditions of the respiratory apparatus, actual disease of 
the air passages or the lungs, and frequent neglect of such condi- 
tions, strongly promote in the Indian the development of pulmonary 
tuberculosis. The infection in such cases would be less frequent, 
however, were the tubercle bacilli less numerous. Noteworthy here 
is the fact that, since assuming the white man's dress, the Indian 
often wears more clothing than he needs, thus making himself 
more susceptible to the inroads of disease. 

(6) The influence of diseases other than those of the respiratory 
tract, on the development of tuberculosis among the Indians, is not 
certain. That of syphilis has surely been overrated; parasitic con- 
ditions need a special study; heart disease — mitral insufficiency of 
rheumatic origin — is very common, as stated before, among the 
Menominee. But no causative relation could be detected between 
this trouble and tuberculosis. 

(7) Dissipation, indolence, and all other weakening conditions 
contribute, doubtless, as much to the susceptibility of the Indian 
to tuberculous infection as they do among the whites. 

(8) Want and consequent debilitation are certainly responsible 
for a percentage of the cases of pulmonary tuberculosis among the 
Indians. Helpless poverty is only too apparent in many of the 
families, particularly among the old people who are often from 
necessity, habit, or other causes, more or less neglected by their 
relatives. In certain localities where there is poverty not apparent 
to the casual observer the food is ordinarily sufficient to sustain life, 
but, owing to the quality, it furnishes little or no surplus energy. 
Under such conditions, any extraordinary demand on the forces of 



32 



BUREAU OF AMERICAN ETHNOLOGY 



[BULL. 42 



the body is- likely to be followed by excessive tissue waste, making 
the individual an easy victim of tuberculous infection. 

(9) The cows kept by the Indians, and the cattle slaughtered for 
food, in no instance have been examined for tuberculosis. In some 
of the tribes the people eat cattle which have died as the result of 
disease. As the meat is not always thoroughly cooked, the intro- 
duction of the tubercle bacillus into the system through this source 
is possible. 

(10) In the nonreservation schools, a factor of importance is the 
depressing effect on the newly-arrived child, of a radically different 
environment. A child taken from a reservation where it has become 
accustomed to almost unrestricted freedom of will and motion, is 
subjected to discipline for at least four-fifths of its waking hours. 
In addition, there are the exertion of studying in a strange language, 
the change of associations, and homesickness, the lack of sufficient 
diversified exercise out of doors, and (to it) unusual food. All these 
influences can not but have a depressing and physically exhausting 
effect, which makes the pupil an easier prey to consumption. 

(11) The mental attitude of the Indian must be taken into ac- 
count because of its unfortunate effect on the course of the disease 
in many cases. The patient utterly gives up the fight against the 
disease as soon as he fully understands that he is infected. This is 
particularly true of the young, the adults showing occasionally some 
of the hopefulness often observed in the white consumptives. 

(12) The mixed-breeds resulting from regular marriages between 
the Indians and the whites appear to be freer from tuberculosis than 
either the full-bloods, or the mixed-breeds due to clandestine unions. 

(13) The effect of close intermarriage is as yet uncertain. 

VII. THERAPEUTICS 

An analysis of the causes of tuberculosis among the Indians leads 
naturally to consideration of the means of preventing or, at least, 
checking the ravages of the disease. In this only a beginning has 
been made. It must be regarded as a misfortune for the Indian 
that he is so isolated from the whites. Had he been in close contact 
with them, the white man in taking care of himself would have been 
obliged, before this, to take care of the Indian also, and tuberculosis 
would not have assumed so large proportions. But even as it is, 
means must to be devised for curbing the infection on the reserva- 
tions and in the schools, for, aside from all considerations regarding 
the Indian, the white man needs to act for his own preservation. 

In addition to preventive measures, suitable treatment must be 
given those already suffering from tuberculosis. One of the most 
important results of the investigation was the finding of a consider- 
able number of cases in which no reasonable doubt could exist as 



hrdliCka] TUBERCULOSIS AMONG CERTAIN INDIAN TRIBES 33 

to the diagnosis, on the way to recovery or actually recovered. 
Such cases, which embrace all ages except perhaps the senile, were 
found in all the tribes, and in a number of instances had been 
watched for years by the local physicians. They prove clearly 
that pulmonary tuberculosis is by no means always fatal in the 
Indian, and justify any adequate measures that maybe taken for the 
cure of the Indian consumptive. 

The writer will now briefly state such measures, particularly in 
the line of prevention, as appear to him of especial importance. 

The first, most important, and most difficult must be the com- 
bating of ignorance. The Indian must be taught how to live, how 
to prepare his food, how to take care of the young, of the old, and of 
the sick, and what precautions to use against the spread of consump- 
tion. His antiquated, erroneous notions concerning disease must 
be gradually dispelled, and be replaced by actual knowledge and a 
clear understanding of the nature of tuberculosis, as of that of 
other contagious infections. The teaching must be applied not only 
to the Indian adults, by means of lectures, demonstrations, special 
bulletins, and through the physicians, but, above all, by means of 
regular instruction to the children from the time of their entrance 
into the schools. For the children are free from many of the preju- 
dices of the adult Indian, and what is imparted to them in a proper 
way will become a stable part of their mental equipment, regulating 
their actions throughout their lives. Not only that, but the children 
thus instructed would themselves influence their parents and rela- 
tives more than an outsider would. Care must be taken, however, 
to make these teachings not a burden of rules to be blindly accepted, 
but a part of the clear understanding and common sense of the 
Indian. It is believed that instruction in this line, on most of the 
reservations and in the larger schools, is exceedingly desirable, and 
should be furnished as soon as possible. 

There is urgent necessity for the general introduction of a simple 
and practicable method for the disposal of the infected sputum. 
Make the Indian fear the sputum of the consumptives as it should 
be feared, and then provide him, or teach him to provide himself, 
with the simplest means possible for its isolation. Cheap and easily 
destructible articles, as toilet paper, are far preferable to the use 
of spittoons, the contents of which, in the absence of sewers, would 
be apt to prove a dangerous source of infection. The Indian should 
be taught to destroy the receptacles by burning, since fire is always 
to be had. The exclusion of flies, which disseminate the infected 
matter, particularly over food, is another necessity. 

A further and very important step will be the isolation of all 
cases, under the care of the nurse and the physician. There will be 



34 



BUREAU OF AMERICAN ETHNOLOGY 



[BULL. 42 



difficulties in the way, but they can be overcome. The problem pre- 
sented demands careful study of the conditions on each reservation, 
and thorough preliminary experiments, particularly in the matter 
of housing the patients. This subject again will require a clear 
understanding by the Indians concerned of what is being done and 
the reasons therefor. 

Further in the line of prevention, it is urged that wherever possible 
the earthen floors of the dwellings be replaced by those made of 
boards, which can be better cleaned. The habit of passing the pipe 
should be discouraged, as well as that of using and passing dishes 
and spoons which have not been properly cleaned. The use by others 
of clothing worn by consumptives, and of articles made or kept in their 
houses, should be prohibited, until such objects shall have been 
rendered aseptic. In this connection it is well to point out the 
advisability of obliging dealers in Indian curios to disinfect all fabrics 
and old articles coming from the reservations. Such articles often 
lie on the floors of infected dwellings and not a few are made by con- 
sumptives. The Navaho blankets are perhaps the freest from infec- 
tion, the tribe being still about the healthiest of our Indians; never- 
theless, the precaution should be carried out even with these. The 
danger of handling articles coming from Indian homes, particularly 
fabrics, before disinfection, needs to be well appreciated also in the 
various museums. 

General cleanliness of houses and their contents, of clothing, and 
of the person should be encouraged among the Indians in the most 
thorough and systematic manner. In a few localities, visited during 
the writer's former journeys, it was noticed that some of the field 
matrons did very good work in this direction. It is thought that 
excellent use could be made of the Indian police in this work, under 
the instruction and supervision of the agency physician. These men, 
who are generally willing and intelligent, could be trained not only to 
spread among these people much useful information regarding tuber- 
culosis and its prevention, but also to do regular duty as a sort of sani- 
tary inspection corps; they could be actually constituted a corps of 
sanitary officers, who should visit monthly each dwelling in the 
territory assigned them, to report on its cleanliness. Such super- 
vision would soon teach the people to keep their dwellings in a more 
hygienic condition. The inveterately neglectful or filthy should be 
punished as are drunkards or other transgressors. These measures 
should be accompanied by judicious efforts to raise the Indian's 
pride and ambition in the directions indicated. 

In addition to the above measures, an improvement is called for 
in the nutrition of many of the Indians, particularly the aged. This 
is a serious problem and needs careful consideration. The most 



HRDLifKA] TUBERCULOSIS AMONG CERTAIN INDIAN TRIBES 



35 



important phase will be to provide all the able-bodied men with 
suitable and remunerative work, which should be, above all, of a 
nature to be enjoyed. The Indian is not inherently lazy. 

Alcoholism should be repressed. The inclination to drink is, how- 
ever, often due, as among the whites, to a deficiency in proper nour- 
ishment. Another and most important cause of drunkenness is the 
utter ignorance of the Indian as to its deleterious effects on his health. 

No effort should be spared to bring the Indian medical service to 
the highest degree of efficiency and dignity. 

Special precautions are called for in the large schools, particularly 
the nonreservation schools. In the first place, the tuberculin test 
should always be applied to those who are to be taken to such 
schools, and all cases where the reaction points to tuberculosis should 
be denied admission. Introduction of the child into the changed 
conditions of life should be very gradual. There should be ample 
opportunity for out-of-door play, and for the systematic exercise 
needed. Swimming pools must not be allowed to become polluted. 
Excursions away from the school, particularly into the hills, have 
shown very encouraging results and should be frequently under- 
taken. Other important desiderata for the pupils are nourishing 
food, eaten under the most enjoyable conditions, attention to indi- 
vidual cases, and care as to their general mental tone. The 
mouthpieces of musical instruments, cups for water, and faucets 
at which children drink, should be regularly disinfected, and the 
indiscriminate use of musical instruments should be discouraged. 
Weekly weighings of all the pupils should be practised, for a continu- 
ous loss of weight is one of the first and most important indications 
of failing health. The children should have no contact with con- 
sumptive teachers, employees, or outsiders and should be well 
instructed as to the dangers of tuberculous infection. Finally, all 
pupils who become seriously ill, without delay and without being made 
to feel that they are very sick, should be separated from the others, 
relieved of regular duties, and given special attention, particularly in 
regard to food and outings. If the child is kept until it has a well- 
developed case of phthisis and is then sent back to the reservation, 
the results are certain to prove unfortunate. Opportunity is 
given the child to infect objects with which it comes in contact, and 
possibly other pupils ; it is deprived of a chance of cure, and is sent back 
at the height of the disease to infect the camp of the family. The 
schoolrooms are generally good, yet the open-air schools about to be 
introduced by the authorities of the Indian Office must certainly 
be regarded as a further step in the right direction. The principle 
should be extended also, where possible, to the workrooms and 
dining rooms for the children. Extermination of flies at the schools 
would aid in preventing infection. 



36 



BUKEAU OF AMEKICAN ETHNOLOGY 



[bull. 42 



If the steps above outlined are taken in a determined manner, it 
is certain that speedy progress can be made in preventing and 
curing tuberculosis among the Indians. Fortunately, improvement 
of existing conditions is being brought about as speedily as is practi- 
cable, by the Indian authorities. 

In conclusion, it is well to reflect that whatever is done for the 
Indian in preventing and curing tuberculosis will be of potential 
civilizing influence for the race and will mean also an advance in the 
campaign against the other pathological conditions to which hi is 
subject. 



BIBLIOGRAPHY 



This bibliography is added as a help to the student of the subject, 
but has no claim to completeness. For additional literature, see the 
bibliography in Bulletin 34 of the Bureau of American Ethnology. 
Minor notes on "scrofula" or "consumption" are scattered through 
the reports of many travelers, missionaries, and other early writers 
which deal with the Indians. 

Andrew, J. The Lumleian lectures on the aetiology of phthisis. Brit. Med. Jour., 
April, 1884, 655-59. 

In 1881-82 consumption was prevalent among the Indians along the northern 
shore of Hudson bay. 

Blaschke, E. Topographia medica portus Novi-Archangelscensis. Petropoli, 1842, 
62, 66-69. 

Reports consumption and scrofula to be common among the natives of the region. 
Bouchardat, M. L'Ann, de therap., Par., 1861, 71. 

Gives a note on tuberculosis among the Hudson Bay Eskimo. 
Brewer, I. W. Tuberculosis among the Indians of Arizona and New Mexico. 
N. Y. Med. Jour., 1906, lxxxiv, 981-83. 

Gives school and reservation physicians' reports on tuberculosis among the 
Indians in Arizona and New Mexico. 

Bull, H. R. Tuberculosis among the Indians. Trans. Colo. Med. Soc, Denver, 
1894, 314-21. 

Reports on cases of tuberculosis under his observation during five years at the 
Grand Junction school for the Indians. 

Coindet, L. Hygiene des altitudes du Mexique. Mem. de med. milit., 1869, 
xxn, 209. 

Reports that subsequent to the siege of Puebla, Mexico, phthisis prevailed among 
the Indian and Creole captives after they were brought to Oriza'ba. 
Farnham's travels in the great western prairies, etc., 1839, in Early Western Travels, 
Thwaite's ed., xxvm, 159. 

Speaking of the "Chippeways," the writer says: "They have conjurers who cure 
diseases — as rheumatism, flux, and consumption." 

Fox, Carroll. Tuberculosis among the Indians of southeastern Alaska. Public 
Health Reports, Marine Hos. Ser., xvi, pt. n, 1615-16, 1901, Washington, 1902. 
Comments on the prevalence of all forms of tuberculosis among the natives of south- 
eastern Alaska; no statistics. 

Glisan, R. Climate and diseases of Oregon. Amer. Jour. Med. Sci., 1865, 73-82. 

Page 79: "At the close of the Rogue river war the scattered remnants of all the 
tribes of Indians in Oregon, west of the Cascade mountains, were moved on a reserva- 
tion lying between the Willamette valley and the Pacific ocean, the total number 
being about 5,000 souls." . . . "Here they enjoyed moderate health for a short period 
only. Diarrhoea, dysentery, pneumonia, consumption, and scrofula, in all its varie- 
ties, soon became prevalent, and carried them off in large numbers." 

The article contains no statistics or history. 

37 



38 



BUREAU OF AMERICAN ETHNOLOGY 



[bull. 42. 



Graham, J. B. Scrofula among the Sioux Indians; its origin and nature. Amer. 
Pract. and News, Louisville, Ky., 1890, ix, 1-5. 
At the time of the writing scrofula was prevalent in the tribe. 

Pages 3-4 : ' ' According to Alex . Rencountre and others, the first case of scrofula (par- 
ticularly) noticed among the Brule Sioux occurred in 1869." . . . "I do not think 
the case referred to as occurring in 1869 was the first case of scrofula among them, but 
it certainly did not exist to an alarming extent before that time." 

"The older Indians and their traditions say that scrofula, syphilis, and consumption 
were little or almost unknown among them until within the last 50 years." 

Seemingly some connection between scrofula and introduction of cattle (rations) in 
1868. 

Guilbert, Ch. A. De la phthisis pulmonaire dans ses rapports avec l'altitude et avec 
les races au Perou et en Bolivie. These, Par., 1862. 
Pages 19-20: The full-blood Indians are almost exempt from consumption. The 
population of Peru is attacked by tuberculosis in the following order of frequency: 
Negro, pure descendants of the old Spanish, mixed-bloods, Europeans, full-blood 
Indians. 

Page 44: In Bolivia, phthisis "is not encountered among the natives." 

Page 59: "The Indian race has hitherto escaped tuberculisation." 

Page 70: "The Araucanian tribes who occupy the country between the Cordilleras 
and the sea, below the 36th degree of southern latitude, are completely exempt of 
tuberculisation. The disease is equally unknown in Patagonia." 
Heger, A. Sanitary report, Fort Simcoe, Wash. Ter., U. S. A. Reports 1855-59, 
Washington, 1860, 263. 

Speaking of the Yakima in 1857, the writer says: "Their prominent diseases are 
phthisis, catarrhal and rheumatic affections, fevers, scrofula, variola, and venereal 
diseases." 

"Scrofula is of frequent occurrence; phthisis is very prevalent among them and al- 
ways fatal." 

Hildreth, S. P. On the climate and diseases of Washington county, Ohio. Amer. 
Jour. Med. ScL, Feb., 1830. 

Treats of the period of the settlement of the region by whites, from 1788 to 1807. 

Page 326: "The aborigines were subject to few diseases, and those of an inflammatory 
nature." . . . "Phthisis pulmonalis, at this early period, was a disease nearly or 
wholly unknown . ' ' 

The above has reference more particularly to the whites. Appearance of a few 
cases in 1808, and slow increase thereafter are noted; also that scrofula too was 
increasing (1829). 

Holder, A. B. Papers on diseases among the Indians. Med. Rec.j N. Y., 1892. 

Page 178: Maintains that the Indians were never free from tuberculosis or scrofula; 
blames "transition" period for the spread of the diseases. 

Refers to specimen 17,223, Peabody Museum, Cambridge (pictured in Bradford 
and Lovett's Orthopedic Surgery, p. 2) , as showing evidence of prehistoric tuberculosis. 

(jives abstract of reports of agency physicians from twelve reservations, in nearly 
all of which the disease is shown to be prevalent. Among the Hupa, however, 
"consumption very rare — only two or three percent of deaths due to it. Scrofula is 
rare." 

Hrdlicka, Ales. Physiological and medical observations among the Indians of 
southwestern United States and northern Mexico. Bull. 34, B. A. E., Wash- 
ington, 1908, i-vm, 1-425. 
Includes the writer's former observations on tuberculosis among the Indians; a 
detailed account of the 1904 report of the physicians in the Indian Service on the 
morbidity of tuberculosis among the various tribes, and bibliography. 



hrdlicka] TUBERCULOSIS AMONG CERTAIN INDIAN TRIBES 39 



Huber, J. B. Races and peoples with regard to tuberculosis.. Med. News, N. Y., 
' Nov. 12, 1904. 

Page 917: "It seems that the Indian was free from tuberculosis before his con- 
tact with the whites, living as he did in the open air and without alcohol." 

The article contains no original material. 
Hunter, J. D. Memoirs of a captivity among the Indians. Third ed., Lond., 1824. 

Pages 432-3: "Among the Osages I have known two cases of what I now suppose to 
have been white swellings, neither subject was more than fifteen years of age. One 
was of the knee, and the other on the ankle joint." 

Page 435: " Consumption. — This disease but rarely occurs." 

"I have known only a few instances of this complaint amongst the Indians, brought 
on by exposure. Intemperance is the principal cause of its prevalence amongst 
them." 

Pages 444-5: "I have known pulmonary consumption to occur among the Indians. 
It is rarely seen, however, except in those addicted to intemperance - and even in 
these it is by no means so common as among the whites. It is worthy of notice that 
females are not so subject to the disease as males are. I have never known it to affect 
a person before puberty, and very seldom under twenty years of age. It appears in 
far the greater number between the ages of twenty and forty years." 

Remarks on several diseases prevalent among the western Indians, etc. 

Amer. Med. Recorder, Phila,, 1822, v, 408-17. 

Page 416: "I have known pulmonary consumption to occur among the Indians. 
It is rarely seen, however, except in those who are addicted to intemperance, and 
even in these it is by no means so common as among the whites." "I have never 
known it to affect a person before puberty, and very seldom under 20 years of age." 
Females less subject than males. 

The paper contains no data on scrofula. 

Observations on the diseases incident to certain of the North American 

Indian tribes. N. Y. Med. and Phys.Jour., N. Y., 1822, i, 174-9. 

Consumption exists among the Indians — in those who drink (exposure, etc.), but 
also in those who do not. 

The article contains no data on scrofula. 
James's account of S. H. Long's expedition, 1819-20, in Early Western Travels, 
Thwaite's ed., xvi. 

Referring to the plains of the Platte, the upper Arkansas, and the Red River of 
Louisiana, the writer says, page 132: "It is true that few, if any, instances of pul- 
monary consumption occur among the Indians of this region. The same remark is 
probably as true of the original native population of New York and New England." 
Jesuit relations, Thwaite's ed.: 

vi, 263: le Jeune's relation, 1633-34. 

Montagnais: "We had three persons in one cabin afflicted with scrofula — the son 
of the man whose ear was very disgusting and horrid from this disease; his nephew, 
who had it in his neck; and a daughter, who had it under one arm. I do not know 
whether this is the real scrofula; whatever it is, this sore is full of pus, and covered 
with a horrible-looking crust. They are nearly all attacked by this disease when 
young, both on account of their filthy habits and because they eat and drink indis- 
criminately with the sick." 

No reference is made to scars xollowing the sores. Possibly the author includes 
cases of pemphigo contagiosa. 

xli, 195: Father le Mercier's relation, 1653-54, New France Algonquians. 

At Tadoussac a child "was afflicted in a frightful manner with scrofula on his 
neck, and his entire throat was being eaten away by it; while the little girl suffered 
from a hemorrhage which was reducing her to a skeleton." 

a Imperfect translation. Original reads: " Avoit un flux de sang qui la desechoit insques aux os." 



40 



BUREAU OF AMERICAN ETHNOLOGY 



[BULL. 42 



Jesuit relations — Continued. 
xliv, 267: Relation of 1657-58. 

Referring to a full-blood Huron girl, who was to become a nun in the convent, the 
writer says: "He (the Lord) visited her with a malady which is common enough 
among the Savages, being a kind of weakness, together with a slow fever; and this so 
exhausted her that she wasted away before our eyes with an inflammation, accompa- 
nied by a severe cough, which affected her whole chest to such an extent that her 
lungs were gradually destroyed." 
lvii, 165: Relation of 1672-73. 

"A poor woman . . . who had been consumptive for two years." 
lxv, 47: Relation of 1696-1702. 

Montagnais: Referring to the missionary among the people — "sometimes he is 
made ill by the stench of those who have scrofula, with whom he even drinks out of 
the same kettle." 

lxviii, 61: Saguenay relation, 1720-30. 

Montagnais: "All, with the exception of a young child attacked by scrofula, were 
in wonderful health." 

There are only two other references to consumption in the Indians in the Jesuit 
Relations, and both of these are very indefinite. They occur in vol. xn, 7, and vol. 
lv, 205. 

Josselyn, J. New-Englands rarities. Lond., 1672; reprint, Boston, 1865. 

Page 90: "Oak of Cappadocia — excellent for stuffing of the lungs upon colds, short- 
ness of wind, and the ptisick; maladies that the natives are often troubled with." 

An account of two voyages to New England. Boston, 1865; original, Lond., 

1675. 

Page 102: "In New England the Indians are afflicted with pestilent Fevers, Plague, 
Black-pox, Consumption of the Lungs, Falling-sickness, Kings-evil, and a Disease 
called by the Spaniards the Plague in the back, with an Empyema." 
Kneeland, J. On some causes tending to promote the extinction of the aborigines 
of America. Trans. Amer. Med. Ass., Phila., 1865, xv, 253-60. 

Reports on the Onondagas (near Syracuse, N. Y.). Scrofula present in many adults 
and in most children. Consumption prevalent — a large percentage of the deaths in 
the tribe due to this disease. 

Lafitau, J. F. Mceurs des sauvages ameriquains, etc. Par., 2 vols., 1724. 
Deals mainly with the Indians of New France. 

Vol. 2, pp. 360-61: The savages suffered with "maladies scrophuleuses, causees par 
la erudite des eaux, par les eaux de neige, qu'ils sont obliges de faire fondre dans les 
pais de chasse, pour boire, & pour faire cuireleur sagamite. C'est peut-etredu meme 
principe, & de ce qu'ils ont toujours l'estomach & la poitrine decouverte, qu'ils con- 
tractent une espece de phtisie, qui les minant peu a peu, en conduit la plus grande 
partie au Tombeau, & a laquelle ils n'ont pu encore trouver de remede." 

". . . ces sortes d' infirmites . . . les prennent d' ordinaire a la fleur de l'age." 

La Hontan. New voyages to America. Two vols., Lond., 1703. 

Contains observations on the Canadian Indians, period 1683-94. 

ii, 47: "it throws all of 'em into that Languishing Disorder, which we call a Con- 
sumption: They look pale, livid and ghastly like skeletons." 

No notes on scrofula are given. 
Lewis and Clark. Travels to the source of the Missouri river, etc., 1804-1806. 
Lond., 1814. 

Page 341, Chopunnish or Nez Perce: "They are generally healthy — the only dis- 
orders which we have had occasion to remark being of a scrofulous kind, and for 
these, as well as for the amusement of those who are in good health, hot and cold 
bathing is very commonly used." 



hrdlicka] TUBERCULOSIS AMONG CERTAIN INDIAN TRIBES 41 



Page 549: We "had a number of patients afflicted with scrofula, rheumatism, and 
sore eyes." "The scrofulous disorders we may readily conjecture to originate in the 
long confinement to vegetable diet." 
Luckley, Geo. Trans. Amer. Med. Ass., 1857, xi. 

Page 215: "Throughout the country phthisis pulmonalis appears to be the most 
common nonspecific disease with the aborigines." 

"On the coast and in the settled districts, although hardships and scarcity of food 
do not exist in any proportion to what is encountered in the interior, yet the same 
disease is even more common." 

Page 216: "Strumous diseases are very common and are rapidly increasing. The 
most common of these are caries of the spine, morbus coxarius, and glandular ulcera- 
tions." 

Matthews, Washington. Consumption among the Indians. Trans. Amer. Clim. 
Ass., Phila., 1886. 

Notes finding consumption everywhere, except in Owen's valley, California, but 
even there the symptoms of scrofula were not entirely wanting. 

According to his observations, tuberculosis was less common in the tribes he knew, 
during his earlier observations. 

Gives statistics of the diseases at several of the northern agencies. 

Further contribution to the study of consumption among the Indians. Trans. 

Amer. Clim. Ass., Phila., 1888. 

Page 142: "We have evidence that the wildest Indians in the earliest historic 
times were subject to consumption; yet they were not subject to it in a high degree, 
and it is probable that they suffered then from a different form of the malady to that 
which troubles the modern Indian. But we have evidence that scrofula begins to 
prevail among them when they cease to live by chase, and that it is a condition pre- 
disposing to consumption among them." 

Gives information from the physicians at eastern and northern agencies, all relating 
to latter half of nineteenth century. Xo historical documents are included. 
Maximilian's travels in the interior of North America, in Early Western Travels, 
Thwaite's ed., xxn. 

Treats of period 1832-34. 

Page 236: Saukie Indians from lower Missouri — " One of their most distinguished 
warriors . . . suffered severely from consumption." 

Morse, J. A report to the Secretary of War of the TJ. S. on Indian Affairs, etc. New 
Haven, 1822. 

Page 347, appendix: Referring to the Indians east of the Rocky Mountains and 
north of Missouri, the author states that they "are, in general, subject to few diseases. 
The venereal complaint is common to -all the tribes of the North ; many die of a con- 
sumption." 

Morton, S. G. Illustrations of pulmonary consumption, etc. Phila., 1837. 

Includes a letter on consumption among the Indians, by Dr. Z. Pitcher. 

Speaking of the Chippewa, Ottawa, Menominee, Osage, Pawnee, Omaha, Kansas, 
Creeks, Cherokee, Choctaw, Seneca, Shawnee, and Dela wares, the Doctor says: 

Page 312 : ' ' Consumption is a disease familiar to all those with whom I have had 
any personal acquaintance; and I think also that I may go further, and state, with- 
out fear of contradiction, that it is prevalent among all the natives of the northern 
section of our continent . ' ' 

The author learned of the disease among Mandan in Missouri , and from officers of 
the Hudson Bay Company regarding all tribes under their jurisdiction. It is his 
opinion that — 

71530— Bull. 42—09 4 



42 



BUREAU OF AMERICAN ETHNOLOGY 



[bull. 42 



Page 313: "Consumption is of more frequent occurrence than scrofula among the 
Indians;" " . . . scrofula per se is oftenest to be seen in those tribes who stand, 
as it were, midway between the savage and civilized state; but even then not so often 
as consumption . ' ' 

Page 315 (Pitcher): "So far as I am capable of forming an estimate of comparative 
frequency of both scrofula and consumption in the two races, a I should say that the 
result is decidedly in favor of the red man." 

Moses, I. On the medical topography of Astoria, Oregon territory. Amer. Jour. 
Med. Sci., Jan., 1855, 32-46. 
Reports scrofula and phthisis prevalent among the Indians of the region. Gives 
no statistics or history. 

Orton, G. T. Scrofula amongst the Indians. The Manitoba and West Canada Lan- 
cet, Winnipeg, Jan., 1898, v, 214-5. 
Scrofula and consumption noted as generally prevalent among the Indians about 
Lake Winnipeg and along Nelson river. The article contains no material of special 
value. 

Romanowsky. Observations dans les colonies russes de l'Amerique. Jour. Med. 
de Russie, 1848, no. 20. 
Reports phthisis to be very prevalent among the natives of the Aleutian islands, 
principally among the mixed-bloods who lead debilitating lives. 

Ross, A. Adventures of the first settlers on the Oregon or Columbia river. Lond., 
1849. 

Page 308: Tribe Oakinackens, and others — "The diseases most frequent among these 
people are indigestion, fluxes, asthmas, and consumption." 

Adventures of the first settlers on the Oregon or Columbia river. Lond., 

1849; also in Early Western Travels, Thwaite's ed., vn. 
Page 111: Chinooks (period 1810-13) — "Consumption and the venereal disease 
are the complaints most common amongst them." 

Rush, B. Free thoughts upon the cause and cure of the pulmonary consumption. 
Medical Inquiries and Observations, 2d ed., Phila., 1794, i. 
Page 196: "It [pulmonary consumption] is unknown among the Indians in North 
America." 

Stratton, Thomas. Contribution to an account of the diseases of the North Ameri- 
can Indians. Edinburgh Med. and Sur. Jour., 1849, lxxi, 269-83. 

The paper contains Dr. A. Digby's and P. Darling's reports on consumption and 
scrofula among the Ottawa and Chippewa of the Manitoulin island and the Six Nations 
along the Grand river (period, 1840-48). 

According to P. Darling there were among the 800 Ottawa and Chippewa who came 
under his observation — (a) from Oct. 10, 1840; to Aug. 16, 1841: treated, scrofula 2, 
"enlarged glands" 13, consumption not mentioned; (b) from Aug. 16, 1841, to Dec. 31, 
1842: phthisis 12; no mention of scrofulous glands; (c) from Jan. 1, 1844, to Dec. 31, 
1844: phthisis 4; no mention of scrofula; (d) Jan. 1, 1847 to Dec. 31, 1847: phthisis 3; no 
mention of glands. 

According to Doctor Digby there were among the twenty-two hundred Indians be- 
longing to the Six Nations, between March 1, 1847, and March 1, 1848, a total of 54 
deaths, with 4 deaths from phthisis. 

Tschudi, J. J. Uber die geographische Verbreitung, dei Krankheiten in Peru. 
Oester. med. Wochenschr., Wien., 1846, 472-3. 
Reports scrofula as being prevalent in Peru, especially along the coast; "but only 
among the white population and along the coast also among the Negroes. The Indians 
appear to be completely immune against this disease. And the same is true about 
tuberculosis." 



a That is, the whites and the Indians. 



hrdlicka] TUBERCULOSIS AMONG CERTAIN INDIAN TRIBES 



43 



Walker, J. R. Tuberculosis among the Oglala Sioux Indians. Amer. Jour. Med. 
Sci., Phila, and N. Y., Oct., 1906, n. s., cxxxn, 600-605. 
Reports on ten years' observations on tuberculosis among the Oglala; gives but 
limited statistics. 

Wilkes, Chas. Narrative of the U. S. exploring expedition, 1838-1842. Phila., 
1845, iv. 

Page 512: Among the Sachet, Oreg., "pulmonary complaints are very common, 
and occasion great suffering. The diseases most often met with are bronchitis, and 
tubercular consumption." 

Williamson, Thomas. The diseases of the Dakota Indians. Northwestern Med. 
and Sur. Jour., St. Paul, Minn., 1874, iv, 410-19. 

Refers to the Sioux of Minnesota about the Lac qui Parle between 1835 and 1846. 
The article contains observations on about 1,000 individuals. 

Page 412: "Of those over ten'years old who died of disease, I think fully half died 
of consumption." "I do not think it was much more prevalent among the Indians 
than among our white population; while from the fact. that they were all tainted with 
scrofula, their mode of life, etc., it might be expected that it would be very much 
more so." 

' ' The great proportion of phthisis was chiefly owing to so few dying of other diseases. ' ' 

Page 415: Scrofula certainly less prevalent among the Indians of the Plains sub- 
sisting on buffalo meat than among those under his observation; those of the Plains 
"generally appeared real healthy, with the exception of sore eyes." 
Winder, Wm. On Indian diseases and remedies. Brit. -Amer. Jour. Med. and 
Phys. Sci., Montreal, Jan., 1846, i, 255-7. 

Includes a report by Dr. P. Darling; otherwise the article is without value. 
Woodruff, Charles E. Diseases of northern California Indians. Med. Rec, 
N. Y., Jan. 24, 1891, xxxix, 104-6. 

Hupa: Some among them say they had not consumption before the advent of whites. 
"At present time the disease is extremely prevalent and fatal." 

The article contains no exact data. 



INDEX 



Page 

Ages, cases of tuberculosis by 25,26 

Animals, domestic— 

Hupa..., 17 

Menominee 10 

Mohave 18,19 

Oglala Sioux 13 

Quinaielt 15 

Apache— 

morbidity from tuberculosis 4 

mortality from tuberculosis 5 

Arapaho— 

morbidity from tuberculosis 4 

mortality from tuberculosis 5 

Arikara — 

mortality from tuberculosis 5 

Assiniboin— 

morbidity from tuberculosis 4 

mortality from tuberculosis 5 

Bacteriological examinations 7-8 

Bannock— 

morbidity from tuberculosis 4 

mortality from tuberculosis 5 

Birth rate of tribes investigated 20 

Blackfeet agency, Mont., morbidity at, 

from tuberculosis 4 

Breathing in tuberculosis 28 

BRONCHiTis,.cases of approximating tubercu- 
losis 26 

Cantonment agency, Okla., morbidity at, 
from tuberculosis 4 

Catarrhal affections — 

Hupa 16 

Menominee 9 

Causes of tuberculosis. See Etiology. 

Central states, tuberculosis among Indians 
of 2 

Cheyenne— 

morbidity from tuberculosis 4 

mortality from tuberculosis 5 

Cheyenne and Arapaho agency, Okla.— 

morbidity from tuberculosis 4 

mortality from tuberculosis 5 

Chippewa— 

morbidity from tuberculosis 4 

mortality from tuberculosis 5 

Civilization. See Culture. 

Cleanliness as a therapeutic measure 34 

Climate— 

influence on distribution of tuberculosis. 6 

Menominee 20-21 

Phoenix Indian school 22 

See also Physical environment. 
Clothing— 

as a factor in tuberculosis 31 



Page 



Clothing— Continued. 

infection of 34 

notes on — 

Hupa 16,21 

Menominee 9,21 

Mohave 18,21 

Oglala Sioux 12,21 

Phoenix Indian School pupils 23 

Quinaielt 14,21 

CCEUR D'ALENE AGENCY, IDAHO— 

morbidity from tuberculosis 4 

mortality from tuberculosis 5 

Colorado River agency. See Mohave. 

Colorado River Mohave. See Mohave. 

Colville agency, Wash., morbidity at, 

from tuberculosis 4 

Comanche, mortality among, from tubercu- 
losis 5 

Cough as a symptom of tuberculosis 28 

Crow agency, Mont., morbidity at, from 

tuberculosis 4 

Crow Creek agency, S. Dak.— 

morbidity from tuberculosis 4 

mortality from tuberculosis 5 

Crows, morbidity among, from tuberculosis. 4 

Culture, state of— 

Hupa 16,17 

Menominee 9 

Mohave 18,19 

Oglala Sioux 11 

Quinaielt 14,15 

Death rate. See Mortality. 

Devils Lake agency, N. Dak., morbidity 

at, from tuberculosis 4 

Diagnosis of tuberculosis 7-8, 24-27 

Diet. See Food. 

Disinfection as a therapeutic measure 34, 35 

Distribution of tuberculosis 6 

See also names of tribes. 

Drunkenness. See Intoxicants. 

Dwellings, description of 29,30 

Hupa 16,21 

Menominee 9, 21 

Mohave 18,21 

Oglala Sioux 11-12,21 

Quinaielt 14,21 

Eastern Cherokee agency, N. C, mortal- 
ity at, from tuberculosis 6 

Environment— 

schoolchildren 32,35 

tribes visited 20 

See also Physical environment. 

Etiology of tuberculosis, discussion of 29-32 

Examinations, physical, character of 7-8 

45 



46 



INDEX 



Page 

E xhaustion as a symptom of tuberculosis ... 28 
Expectoration as a feature of tuberculosis. . . 28 
Exposure as a factor in tuberculosis 31 

Family groups, statistics of, regarding tuber- 
culosis 24-25,27 

Fever as a symptom of tuberculosis 28 

Finger tips in tuberculosis 28 

Flathead agency Mont. — 

morbidity from u berculosis 4 

mortality from tuberculosis 6 

Flies, precautions against 33, 35 

Food— 

as a factor in tuberculosis 31-32 

improvement needed 34-35 

notes on— 

Hupa 16-17,21 

Menominee 9,21 

Mohave 18-19,21 

Oglala Sioux 12,21 

Quinaielt 14,15,21 

Forms of tuberculosis, statistical data for. . 24-27 

See also Morbidity, Mortality. 
Fort Apache agency, Ariz.— 

morbidity from tuberculosis 4 

mortality from tuberculosis 6 

Fort Belknap agency, Mont.— 

morbidity from tuberculosis 4 

mortality from tuberculosis 5 

Fort Berthold agency, N. Dak.— 

morbidity from tuberculosis 4 

mortality from tuberculosis 5, 6 

Fort Hall, Idaho— 

morbidity from tuberculosis 4 

mortality from tuberculosis 5 

Fort Lewis agency, Colo., mortality at, 

from tuberculosis " 5 

Fort Mohave school, Ariz. See Mohave. 
Fort Peck agency, Mont.— 

morbidity from tuberculosis 4 

mortality from tuberculosis 5 

Fort Totten agency, Ariz., mortality at, 

from tuberculosis 6 

Fort Yuma school and reservation, 

Ariz., morbidity at, from tuberculosis 4 

French, relations of, with Menominee & 

Full-bloods— 

Hupa 16 

Menominee 9 

Mohave 17 

Oglala Sioux 7,11 

susceptibility to tuberculosis 32 

Grand Junction (Colo.) Indian school, 
tuberculosis at 2 

Green Bay agency, Wis — 

morbidity from tuberculosis 4 

mortality from tuberculosis 5 

Grosventres— 

morbidity from tuberculosis 4 

mortality from tuberculosis 5 

Habits of Indians— 

as a factor in tuberculosis 29-30 

of tribes visited 21 

Half-breeds. See Mixed-bloods. 

Heart affections— 

as a factor in tuberculosis 31 

Menominee 10 



Hemoptysis as a symptom of tuberculosis. 28 

Hemorrhages in tuberculosis 28 

Heredity as a factor in tuberculosis 31 

History of tuberculosis among United 

States Indians 1-3 

Hopi— 

morbidity from tuberculosis 4, 7 

mortality from tuberculosis 5 

Hupa— 

conditions in general 20-21 

morbidity from tuberculosis 4 

mortality from tuberculosis 5 

scope of investigations among 7-8 

statistical data regarding tuberculosis . . . 24-27 

Ignorance as a factor in tuberculosis 29-30, 33 

Immunity from tuberculosis. See Suscep- 
tibility. 

Indian Office, work of 2,3,8,36 

medical service 3-7, 35 

police 34 

Indian schools, conditions in 32, 35 

See also Phoenix Indian school. 
Intermarriage as a factor in tuberculosis. . . 32 
Intoxicants, use of— 

as a factor in tuberculosis 31,35 

by tribes— 

Hupa 17 

Menominee 10 

Mohave 19 

Oglala Sioux 13,14 

See also Habits. 
Iroquois, morbidity among, from tubercu- 
losis 4 

Isolation as a preventive measure 33-35 

Jicarilla agency, N. Mex., morbidity at, 
from tuberculosis 4 

Kickapoo, morbidity among, from tubercu- 
losis 4 

Kickapoo school, Kans., morbidity in, from 
tuberculosis 4 

Kinds of tuberculosis, statistical data for . . 24-27 
See also Morbidity, Mortality. 

Kiowa, mortality among, from tuberculosis. 5,6 

Kissing among Indians 30 

La Pointe agency, Wis., mortality at, from 

tuberculosis 5 

Leech Lake agency, Minn., morbidity at, 

from tuberculosis 4 

Lemhi agency, Idaho, morbidity at, from 

tuberculosis . 4 

Lower Brule agency, S. Dak., morbidity 

at, from tuberculosis 4 

Malarial affections (Menominee) 10 

Mandan, mortality among, from tuberculo- 
sis 5 

Menominee— 

conditions in general 8-10, 20-21 

heart disease 31 

morbidity from tuberculosis 4 

mortality from tuberculosis 5 

rheumatic disorders 31 

scope of investigations among 7-8 

statistical data regarding tuberculosis . . . 24-27 

Mental attitude as a factor in tuberculosis. 32 



INDEX 



47 



Mescalero Apache— rage 

. morbidity from tuberculosis 4 

mortality from tuberculosis 5 

Mexicans, effect on Indians of contact with . 6 

Missouri valley, tuberculosis among In- 
dians of 2 

Mixed-bloods 20 

among Menominee 9 

comparatively free from tuberculosis .... 32 

Mixed-breeds. See Mixed-bloods. 

Mohave— 

conditions in general 20-21 

dwellings 30 

exceptional case of enlarged cervical 

glands 27 

morbidity from tuberculosis 4 

mortality from tuberculosis 5 

scope of investigations among 7-8 

statistical data regarding tuberculosis 24-27 

Montaignes, scrofula among 2 

Morbidity from tuberculosis — 

Indians 3-4,6-7 

negroes 6 

whites 6 

Mortality from tuberculosis- 
Indians 3, 5-7, 11, 20, 24-25 

negroes 6 

whites 6 

Muckleshoot, mortality among, from tuber- 
culosis 5 

Navaho— 

comparatively free from tuberculosis 6-7 

conditions in general 34 

morbidity from tuberculosis 4 

- mortality from tuberculosis 5, 6 

Neah Bay agency, Wash., morbidity at, 

from tuberculosis 4 

Negroes of United States, mortality 

among, from tuberculosis 6 

Nevada agency, Nev., morbidity at, from 

tuberculosis 4 

New France tribes, scrofula among 2 

Occupation for Indians, importance of 35 

Occupations— 

Hupa 16-17,21 

Menominee 10,21 

Mohave 18,21 

Oglala Sioux 13,21 

Quinaielt 14-15,21 

Oglala. See Oglala Sioux. 

Oglala Sioux— 

conditions in general 11-14, 20-21, 27 

morbidity from tuberculosis 4 

mortality from tuberculosis 5 

scope of investigations among 7-8 

statistical data regarding tuberculosis . . . 24-27 

Oklahoma, tuberculosis among Indians in. . 6 

Omaha— 

morbidity from tuberculosis 4 

mortality from tuberculosis 6 

Oneida, morbidity among, from tuberculosis 4 

Oto— 

morbidity from tuberculosis 4 

mortality from tuberculosis 5 



Paiute— Page 

morbidity from tuberculosis 4 

mortality from tuberculosis 5 

Panguitch agency, Utah, mortality at, 

from tuberculosis 5 

Papago in Phoenix Indian school, tubercu- 
losis among 25-26 

Parasitic conditions as a factor in tuber- 
culosis 31 

Passing the pipe, relation of to tuber- 
culosis 13-14,30,34 

Pawnee, morbidity among, from tubercu- 
losis 4 

Percussion in chronic tuberculosis 28-29 

Phoenix Indian school— 

conditions in general 22, 25-26 

investigations in 7-8 

Physical environment— 

Hupa 16 

Menominee 8-9 

Mohave ' 17-18 

Oglala Sioux 11 

Quinaielt 14 

Piegan, morbidity among, from tuberculosis 4 

Pima— 

morbidity from tuberculosis 4 

mortality from tuberculosis 6 

Pine Ridge agency, S. Dak. See Oglala 
Sioux. 

Ponca, mortality among, from tuberculosis. 5 
Population statistics— 

Hupa 16,20 

Menominee 20,21 

Mohave 17,20 

Oglala Sioux 11,20 

Quinaielt 14,20 

Port Madison Indians, mortality among, 

from tuberculosis 5 

Potawatomi, morbidity among, from tuber- 
culosis 4 

Poverty as a factor in tuberculosis 31-32 

Prevention of tuberculosis. See Thera- 
peutics. 

Pueblos comparatively free from tubercu- 
losis 6 

Pure-bloods. See Full-bloods. 

Puyallup agency, Wash., morbidity at, 
from tuberculosis 4 

Quileute, morbidity among, from tubercu- 
losis 4 

Quinaielt— 

conditions in general 14-15,20-21 

morbidity from tuberculosis 4 

scope of investigations among 7-8 

statistical data regarding tuberculosis... 24-27 

Recovery from tuberculosis, cases of 32-33 

Red Lake agency, Minn., mortality at, 

from tuberculosis 5 

Respiratory apparatus, various disorders 

of— 

Hupa 16 

Menominee 10 

Rheumatic disorders— 

Hupa 16 

Menominee io 



48 



INDEX 



Page 

Rosebud agency, S. Dak.— 

morbidity from tuberculosis 4 

mortality from tuberculosis 5 

Round Valley agency, Cal.— - 

morbidity from tuberculosis 4 

mortality from tuberculosis 5 

San Carlos agency, Ariz., mortality at, 

from tuberculosis 5 

San Juan agency, N. Mex., morbidity at, 

from tuberculosis 4 

Santa Fe agency, N. Mex., mortality at, 

from tuberculosis 6 

Santee Sioux, mortality among, from tuber- 
culosis 5 

Sauk and Foxes, Okla.— 

morbidity from tuberculosis 4 

mortality from tuberculosis 6 

Scrofula — 

among New France tribes 2 

scrofulous glands classified 24,25 

Sexes— 

morbidity 24-25,26 

proportion of— 

Menominee 8 

Oglala Sioux 11 

Shawnee, morbidity among, from tuberculo- 
sis 4 

Shoshoni — 

morbidity fronAuberculosis 4 

mortality from tuberculosis 5 

Siletz, mortality among, from tuberculosis. . 5 
Siletz agency, Oreg., mortality at, from 

tuberculosis 5 

Sioux — 

dwellings 30 

extent of tuberculous infection 31 

morbidity from tuberculosis 4 

mortality from tuberculosis 5 

pipe passing among 30 

pulmonary tuberculosis among 2 

See also Oglala Sioux, Santee Sioux, Yank- 
ton Sioux. 

Southern Ute, mortality among, from tu- 
berculosis 5 

Sputum of consumptives, disposal of 33 

Standing Rock agency, N. Dak. — 

morbidity from tuberculosis 4 

mortality from tuberculosis 5 

Susceptibility to tuberculosis 1, 22, 31, 32 

Sweats as a symptom of tuberculosis 28 



Page 

Swinomish, mortality among, from tubercu- 
losis 5 

Symptoms of tuberculosis in Indians 28-29 

Syphilis as a factor in tuberculosis 31 

Taholah, Quinaielt village 14 

Tarasco, diseases of chest among 2 

Therapeutics, discussion of 32-36 

Tongue River agency, Mont., morbidity 

at, from tuberculosis 4 

Tonkawa, mortality among, from tubercu- 
losis * 5 

Tonsilitis (Hupa) 16 

Tribes investigated 7 

Truxton Canyon agency, Ariz., morbidity 

at, from tuberculosis 4 

Tuberculin tests, use of 26, 35 

Tulalip agency, Wash., mortality at, from 

tuberculosis 5,6 

Uintah and Ouray agency, Utah, mortal- 
ity at, from tuberculosis 5 

Umatilla agency, Oreg., morbidity at, 

from tuberculosis 4 

United States Census reports on tuber- 
culosis among Indians 2,3 

Ute, mortality among, from tuberculosis 5 

Ute agency, Utah, morbidity at, from tu- 
berculosis 4 

Walapai, morbidity among, from tuberculo- 
sis 4 

Walker River agency, Nev., mortality at, 

from tuberculosis : 5 

Weight as an index of health 35 

Western Shoshoni agency, New— 

morbidity from tuberculosis 4 

mortality from tuberculosis 5 

Whites— 

compared with Indians regarding tuber- 
culosis 26 

effect on Indians of contact with 6-7 

mortality from tuberculosis 6 . 

susceptibility to tuberculosis 22, 30 

Wichita, mortality among, from tuberculosis 5 

Winnebago— 

morbidity from tuberculosis 4 

mortality from tuberculosis 5 

Yankton Sioux— 

morbidity from tuberculosis 4 

mortality from tuberculosis 5 

Yuma, morbidity among, from tuberculosis. 4 



o 



BUREAU OF AMERICAN ETHNOLOGY 



BULLETIN 42 PLATE 1 




Dwelling in an ideal location 
MENOMINEE VILLAGE AND ISOLATED HOUSE 



BUREAU OF AMERICAN ETHNOLOGY 



BULLETIN 42 PLATE 2 




Log-and-plank house of average size 
MENOMINEE. HOUSES 



BUREAU OF AMERICAN ETHNOLOGY 



BULLETIN 42 PLATE 3 




MENOMINEE HOUSES AND FARM 



BUREAU OF AMERICAN ETHNOLOGY 



BULLETIN 42 PLATE 5 




Isolated house; the character of the country is here shown 
OGLALA DWELLINGS 



BUREAU OF AMERICAN ETHNOLOGY 



BULLETIN 42 PLATE 6 




OGLALA TENT DWELLINGS 

In the lower picture may be seen strips of beef hanging from poles to dry 



BUREAU OF AMERICAN ETHNOLOGY BULLETIN 42 PLATE 7 




A small house of typical construction 




A house of average size, with an exceptionally large window 
OGLALA LOG HOUSES 



BUREAU OF AMERICAN ETHNOLOGY 



BULLETIN 42 PLATE 8 




OGLALA DWELLINGS 

Log houses, double and single, tents, and brush shelters 



BUREAU OF AMERICAN ETHNOLOGY BULLETIN 42 PLATE 12 




QUINAIELT CHILDREN; SPECIMENS OF BASKETRY 



BUREAU OF AMERICAN ETHNOLOGY 



BULLETIN 42 PLATE 13 




A group in the northeastern extremity of Hupa valley 
HUPA DWELLINGS 



BUREAU OF AMERICAN ETHNOLOGY 



BULLETIN 42 PLATE 14 




A portion of an orchard may here be seen 
HUPA DWELLINGS 



BUREAU OF AMERICAN ETHNOLOGY 



BULLETIN 42 PLATE 16 




HUPA LARGE FRAME HOUSES 

In the lower house the windows are on the other side and in the ends 



BUREAU OF AMERICAN ETHNOLOGY 



BULLETIN 42 PLATE 17 




"Captain John's Camp " 
HUPA DWELLINGS OF THE POORER CLASS 



BUREAU OF AMERICAN ETHNOLOGY 



BULLETIN 42 PLATE 18 




Pole-and-brush shelter of a consumptive 
MOHAVE SHELTERS 



BUREAU OF AMERICAN ETHNOLOGY 



BULLETIN 42 PLATE 19 




"Open-work" house 
MOHAVE DWELLINGS 



BUREAU OF AMERICAN ETHNOLOGY 



BULLETIN 42 PLATE 20 




Frame house, with attached pole-and-brush shelter 
MOHAVE DWELLINGS 



BUREAU OF AMERICAN ETHNOLOGY 



BULLETIN 42 PLATE 21 




Reed-and-adobe house 
MOHAVE DWELLINGS AND SWEAT HOUSE 



BUREAU OF AMERICAN ETHNOLOGY 



BULLETIN 42 PLATE 22 




A house of the better class 
MOHAVE DWELLINGS 



LIBRARY OF CONGRESS 




0 011 793 902 9 



